Methylphenidate effect on attention deficit in the acutely brain-injured adult.

Abstract

To determine the efficacy of methylphenidate in improving attention and functional outcome in acutely brain-injured adults. Prospective multiple baseline design (A-A-B-A) utilized on a consecutive sample of patients. Acute brain injury rehabilitation unit in a large academic medical center. Eleven acutely brain-injured adults were included by performing below two standard deviations of the age equivalent norms on 4 of 5 neuropsychological tests for attentional capacity. One subject was withdrawn after developing tachycardia. After a 1-week baseline assessment, subjects were placed on increasing doses of methylphenidate (Ritalin) so that on Day 7 all patients received a dose of 15 mg at 8 am and 12 pm. Nine neuropsychological subtests measured attention on admission, at 1 week, while on methylphenidate, and 1 week after its discontinuation. Functional outcome was evaluated utilizing the Disability Rating Scale (DRS) at the same intervals. Digit Span, Mental Control, and Symbol Search scores improved significantly (p < .05) on methylphenidate (A-B) as compared with the pre-methylphenidate (A-A) period. This advantage remained when the drug was removed. The mean improvement in DRS scores on methylphenidate approached a significant difference (p < .06) from that change in the DRS scores between baseline 1 and 2. Use of methylphenidate in acutely brain-injured adults was well tolerated and demonstrated a significant improvement in attention compared to natural recovery in a rehabilitation setting. Methylphenidate also correlated with faster functional recovery as measured by the Disability Rating Scale although the improvement did not achieve statistical significance.