1
|
Adamski J, Langford V, Finlay JL. Approaches to Minimise the Neurodevelopmental Impact of Choroid Plexus Carcinoma and Its Treatment. Life (Basel) 2023; 13:1855. [PMID: 37763259 PMCID: PMC10533047 DOI: 10.3390/life13091855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023] Open
Abstract
Choroid plexus carcinomas (CPC) are rare aggressive tumours that primarily affect very young children. Treatment for CPC typically involves a combination of surgery, chemotherapy, and radiation therapy. Whilst considered necessary for a cure, these therapies have significant neurocognitive consequences for patients, negatively impacting cognitive function including memory, attention, executive functioning, and full-scale intelligence quotients (FSIQ). These challenges significantly impact the quality of life and ultimately socioeconomic parameters such as the level of educational attainment, marital status, and socioeconomic status. This review looks at the tumour- and treatment-related causes of neurocognitive damage in CPC patients and the progress made in finding strategies to reduce these. Opportunities to mitigate the neurodevelopmental consequences of surgery, chemotherapy, and radiation therapy are explored in the context of CPC treatment. Evaluation of the pathological and biological mechanisms of injury has identified innovative approaches to neurocognitive protection and neurorehabilitation, which aim to limit the neurocognitive damage. This review aims to highlight multiple approaches physicians can use when treating young children with CPC, to focus on neurocognitive outcomes as a measure of success.
Collapse
Affiliation(s)
- Jenny Adamski
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK;
| | - Vikki Langford
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK;
| | - Jonathan L. Finlay
- Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
| |
Collapse
|
2
|
Bindu GSS, Thekkekkara D, Narayanan TL, Narayanan J, Chalasani SH, Manjula SN. The Role of TGF-β in Cognitive Decline Associated with Radiotherapy in Brain Tumor. J Pharmacol Pharmacother 2022. [DOI: 10.1177/0976500x221107503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cognitive decline is a late adverse event in brain tumor survivors. The patients receiving radiation treatment exhibit a wide range of damage and impairment in attention, memory, and executive function compared to the untreated group. After radiation treatment, various changes are observed in astrocytes, oligodendrocytes, white matter, and vasculature. The major affected areas are the hippocampus and prefrontal cortex. Neurogenesis impairment is one of the primary mechanisms responsible for cognitive dysfunction. Various cytokines and growth factors are responsible for inducing apoptosis of neural cells, which results in impaired neurogenesis in response to radiotherapy. Transforming growth factor (TGF-β) is one of the key cytokines released in response to radiation. TGF-β plays a major role in neuronal apoptosis through various pathways such as the MAP kinase pathway, JAK/STAT pathway, and protein kinase pathway. In contrast, activation of the ALK5 pathway via TGF-β improves neurogenesis. So, the current review article focuses on the detailed effects of TGF-β on neuronal cells concerning radiation exposure. This in-depth knowledge will help researchers focus more on the TGF-β pathway and come up with new treatment schedules which will help reduce cognitive dysfunctions in brain tumor patients produced as a result of radiation therapy.
Collapse
Affiliation(s)
- G. S. Swarna Bindu
- Department of Pharmacology, JSS College of Pharmacy, JSSAHER, SS Nagar, Mysuru, Karnataka, India
| | - Dithu Thekkekkara
- Department of Pharmacology, JSS College of Pharmacy, JSSAHER, SS Nagar, Mysuru, Karnataka, India
| | - T. Lakshmi Narayanan
- Department of Pharmacology, JSS College of Pharmacy, JSSAHER, SS Nagar, Mysuru, Karnataka, India
| | - Jiju Narayanan
- Department of Pharmacology, JSS College of Pharmacy, JSSAHER, SS Nagar, Mysuru, Karnataka, India
| | - Sri Harsha Chalasani
- Department of Pharmacy Practice, JSS College of Pharmacy, JSSAHER, SS Nagar, Mysuru, Karnataka, India
| | - S. N. Manjula
- Department of Pharmacology, JSS College of Pharmacy, JSSAHER, SS Nagar, Mysuru, Karnataka, India
| |
Collapse
|
3
|
Current Clinical Trials in Traumatic Brain Injury. Brain Sci 2022; 12:brainsci12050527. [PMID: 35624914 PMCID: PMC9138587 DOI: 10.3390/brainsci12050527] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 12/10/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the leading causes of morbidity, disability and mortality across all age groups globally. Currently, only palliative treatments exist, but these are suboptimal and do little to combat the progressive damage to the brain that occurs after a TBI. However, multiple experimental treatments are currently available that target the primary and secondary biochemical and cellular changes that occur after a TBI. Some of these drugs have progressed to clinical trials and are currently being evaluated for their therapeutic benefits in TBI patients. The aim of this study was to identify which drugs are currently being evaluated in clinical trials for TBI. A search of ClinicalTrials.gov was performed on 3 December 2021 and all clinical trials that mentioned “TBI” OR “traumatic brain injury” AND “drug” were searched, revealing 362 registered trials. Of the trials, 46 were excluded due to the drug not being mentioned, leaving 138 that were completed and 116 that were withdrawn. Although the studies included 267,298 TBI patients, the average number of patients per study was 865 with a range of 5–200,000. Of the completed studies, 125 different drugs were tested in TBI patients but only 7 drugs were used in more than three studies, including amantadine, botulinum toxin A and tranexamic acid (TXA). However, previous clinical studies using these seven drugs showed variable results. The current study concludes that clinical trials in TBI have to be carefully conducted so as to reduce variability across studies, since the severity of TBI and timing of therapeutic interventions were key aspects of trial success.
Collapse
|
4
|
Verduzco-Mendoza A, Carrillo-Mora P, Avila-Luna A, Gálvez-Rosas A, Olmos-Hernández A, Mota-Rojas D, Bueno-Nava A. Role of the Dopaminergic System in the Striatum and Its Association With Functional Recovery or Rehabilitation After Brain Injury. Front Neurosci 2021; 15:693404. [PMID: 34248494 PMCID: PMC8264205 DOI: 10.3389/fnins.2021.693404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/03/2021] [Indexed: 01/06/2023] Open
Abstract
Disabilities are estimated to occur in approximately 2% of survivors of traumatic brain injury (TBI) worldwide, and disability may persist even decades after brain injury. Facilitation or modulation of functional recovery is an important goal of rehabilitation in all patients who survive severe TBI. However, this recovery tends to vary among patients because it is affected by the biological and physical characteristics of the patients; the types, doses, and application regimens of the drugs used; and clinical indications. In clinical practice, diverse dopaminergic drugs with various dosing and application procedures are used for TBI. Previous studies have shown that dopamine (DA) neurotransmission is disrupted following moderate to severe TBI and have reported beneficial effects of drugs that affect the dopaminergic system. However, the mechanisms of action of dopaminergic drugs have not been completely clarified, partly because dopaminergic receptor activation can lead to restoration of the pathway of the corticobasal ganglia after injury in brain structures with high densities of these receptors. This review aims to provide an overview of the functionality of the dopaminergic system in the striatum and its roles in functional recovery or rehabilitation after TBI.
Collapse
Affiliation(s)
- Antonio Verduzco-Mendoza
- Ph.D. Program in Biological and Health Sciences, Universidad Autónoma Metropolitana, Mexico City, Mexico
- Division of Biotechnology-Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Paul Carrillo-Mora
- Division of Neurosciences, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Alberto Avila-Luna
- Division of Neurosciences, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Arturo Gálvez-Rosas
- Division of Neurosciences, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Adriana Olmos-Hernández
- Division of Biotechnology-Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Daniel Mota-Rojas
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Antonio Bueno-Nava
- Division of Neurosciences, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| |
Collapse
|
5
|
Abstract
BACKGROUND This study aimed to evaluate the effect of methylphenidate for treating mental sequelae after traumatic brain injury (TBI). METHODS Thirty-six patients with TBI were randomly divided into the intervention group and placebo group. The participants in the intervention group received methylphenidate, while subjects in the placebo group were administered a placebo. This study was conducted from January 2014 to December 2016. The outcome measurements included Mental Fatigue Scale, Choice Reaction Time, Compensatory Tracking Task, Mental Arithmetic Test, Digit Symbol Substitution Test, Mini-Mental State Examination (MMSE), Beck Depression Inventory (BDI), and Hamilton Rating Scale for Depression. In addition, safety was also recorded and assessed. RESULTS A total of 33 subjects completed the study. Methylphenidate showed greater efficacy than placebo, with decreased scores on the Mental Fatigue Scale, Choice Reaction Time, and Compensatory Tracking Task in the intervention group compared to the placebo group (P < .01, respectively). Furthermore, increased scores on the Mental Arithmetic Test, Digit Symbol Substitution Test, and MMSE in the intervention group, compared to those in the placebo group (P < .01 respectively), were observed. In addition, a significant difference in the scores on the BDI (P = .04) and Hamilton Rating Scale for Depression (P = .005) was observed between the 2 groups. The safety at the end of the 30 week-treatment was similar between the 2 groups (P > .05). CONCLUSION The results of this study demonstrated that methylphenidate could effectively improve mental fatigue and cognitive functions in patients with TBI.
Collapse
Affiliation(s)
- Wei-Tao Zhang
- Department of Neurosurgery, The People's Hospital of Yan’an, Yan’an
| | - Ya-Fei Wang
- Department of Neurosurgery, The People's Hospital of Ningxia, Yinchuan, China
| |
Collapse
|
6
|
Huang CH, Huang CC, Sun CK, Lin GH, Hou WH. Methylphenidate on Cognitive Improvement in Patients with Traumatic Brain Injury: A Meta-Analysis. Curr Neuropharmacol 2016; 14:272-81. [PMID: 26951094 PMCID: PMC4857625 DOI: 10.2174/1570159x13666150514233033] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 02/28/2015] [Accepted: 05/12/2015] [Indexed: 11/22/2022] Open
Abstract
Although methylphenidate has been used as a neurostimulant to treat patients with attention deficit hyperactivity disorder, its therapeutic role in the psychomotor or cognitive recovery of patients with traumatic brain injuries (TBIs) in both intensive care and rehabilitation settings has not been adequately explored. To address this issue, this meta-analysis searched the available electronic databases using the key words “methylphenidate”, “brain injuries”, “head injuries”, and “traumatic brain injury”. Analysis of the ten double-blind RCTs demonstrated significant benefit in using methylphenidate for enhancing vigilance-associated attention (i.e., selective, sustained, and divided attention) in patients with TBIs (standardized mean difference: 0.45, 95% CI: 0.10 to 0.79), especially in sustained attention (standardized mean difference: 0.66, 95% CI: 0.22 to 1.10). However, no significant positive impact was noted on the facilitation of memory or processing speed. More studies on the efficacy and safety of methylphenidate for the cognitive improvement of patients with TBIs are warranted.
Collapse
Affiliation(s)
| | | | | | | | - Wen-Hsuan Hou
- Master Program in Long- Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan, No 250 Wuxing Street, Taipei City, 11031, Taiwan, R.O.C.
| |
Collapse
|
7
|
Kim SJ, Park MH, Lee JW, Chung NG, Cho B, Lee IG, Chung SY. Neurocognitive outcome in survivors of childhood acute lymphoblastic leukemia: experience at a tertiary care hospital in Korea. J Korean Med Sci 2015; 30:463-9. [PMID: 25829815 PMCID: PMC4366968 DOI: 10.3346/jkms.2015.30.4.463] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 11/27/2014] [Indexed: 12/04/2022] Open
Abstract
This study was conducted to investigate long-term neurocognitive outcomes and to determine associated risk factors in a cohort of Korean survivors of childhood acute lymphoblastic leukemia (ALL). Forty-two survivors of ALL were compared with 42 healthy controls on measures of a neurocognitive test battery. We analysed potential risk factors (cranial irradiation, sex, age at diagnosis, elapsed time from diagnosis, and ALL risk group) on neurocognitive outcomes. ALL patients had lower, but non-significant full-scale intelligence quotient (FSIQ, 107.2±12.2 vs. 111.7±10.2), verbal intelligence quotient (VIQ, 107.7±13.6 vs. 112.2±11.4), and performance intelligence quotient (PIQ, 106.3±14.2 vs. 110.1±10.7) scores than healthy controls. However, patients treated with cranial irradiation performed significantly lower on FSIQ (102.2±8.1), VIQ (103.3±11.7), and PIQ (101.4±13.2) compared to non-irradiated patients and healthy controls. ALL patients also had poor attention, concentration, and executive functions. Among ALL survivors, cranial irradiation was a risk factor for poor FSIQ, being male was a risk factor for poor PIQ, and younger age was a risk factor for poor attention. Therefore, the delayed cognitive effects of ALL treatment and its impact on quality of life require continuing monitoring and management.
Collapse
Affiliation(s)
- Seong Joon Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, St. Vincent Hospital, Suwon, Korea
| | - Min Hyun Park
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, St. Vincent Hospital, Suwon, Korea
| | - Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Nak Gyun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Bin Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - In Goo Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Seung Yun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea
| |
Collapse
|
8
|
Ikeda H, Kawase T, Nagasawa M, Chowdhury VS, Yasuo S, Furuse M. Metabolism of amino acids differs in the brains of Djungarian hamster (P. sungorus) and Roborovskii hamster (P. roborovskii). SPRINGERPLUS 2014; 3:277. [PMID: 24936396 PMCID: PMC4057556 DOI: 10.1186/2193-1801-3-277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 05/22/2014] [Indexed: 11/22/2022]
Abstract
Djungarian hamster (P. sungorus) and Roborovskii hamster (P. roborovskii) belong to the same genus of phodopus. Roborovskii hamster shows high locomotor activity and low level of dopamine (DA) in the brain. Administration of L-tyrosine, a precursor of DA, decreases locomotor activity in Roborovskii hamsters. However, the amino acid metabolism in relation to the hyperactivity is not yet well known. In the present study, L- and D-amino acid concentrations in the brain, liver, and plasma in Djungarian and Roborovskii hamsters were investigated during day and night times to explain the possible difference in hyperactivity between them. Most of the examined amino acids were higher in the night time when hamsters are active compared to those in day time. L- and D-tyrosine concentrations were higher in the liver of Roborovskii hamsters than in Djungarian hamsters. Furthermore, brain concentration of D-tyrosine was higher in the Roborovskii than in Djungarian hamsters, but no significant difference was observed for L-tyrosine concentrations between the two species. These results suggest that the conversion of L-tyrosine to D-tyrosine in the brain of Roborovskii hamster may be higher than in Djungarian hamster, which may cause low DA concentration and hyperactivity in Roborovskii hamster. On the other hand, L- and D-serine, which are known as sedative factors, were lower in Roborovskii hamsters than Djungarian hamster. These results suggest that species-specific regulation in amino acid metabolism may contribute to hyperactivity in Roborovskii hamsters.
Collapse
Affiliation(s)
- Hiromi Ikeda
- Laboratory of Regulation in Metabolism and Behavior, Faculty of Agriculture, Kyushu University, Fukuoka, 812-8581 Japan
| | - Takahiro Kawase
- Laboratory of Regulation in Metabolism and Behavior, Faculty of Agriculture, Kyushu University, Fukuoka, 812-8581 Japan
| | - Mao Nagasawa
- Laboratory of Regulation in Metabolism and Behavior, Faculty of Agriculture, Kyushu University, Fukuoka, 812-8581 Japan
| | - Vishwajit Sur Chowdhury
- Division for Arts and Science, Faculty of Arts and Science, Kyushu University, Fukuoka, 819-0395 Japan
| | - Shinobu Yasuo
- Laboratory of Regulation in Metabolism and Behavior, Faculty of Agriculture, Kyushu University, Fukuoka, 812-8581 Japan
| | - Mitsuhiro Furuse
- Laboratory of Regulation in Metabolism and Behavior, Faculty of Agriculture, Kyushu University, Fukuoka, 812-8581 Japan
| |
Collapse
|
9
|
|
10
|
Bechtel N, Kobel M, Penner IK, Specht K, Klarhöfer M, Scheffler K, Opwis K, Schmitt-Mechelke T, Capone A, Weber P. Attention-deficit/hyperactivity disorder in childhood epilepsy: A neuropsychological and functional imaging study. Epilepsia 2012; 53:325-33. [DOI: 10.1111/j.1528-1167.2011.03377.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Koneski JAS, Casella EB, Agertt F, Ferreira MG. Efficacy and safety of methylphenidate in treating ADHD symptoms in children and adolescents with uncontrolled seizures: a Brazilian sample study and literature review. Epilepsy Behav 2011; 21:228-32. [PMID: 21524941 DOI: 10.1016/j.yebeh.2011.02.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 02/25/2011] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is observed in 30% of children and adolescents with epilepsy. Recent studies have demonstrated the safety of methylphenidate (MPH) in patients with controlled epilepsy. There are few studies of patients with uncontrolled epilepsy. The goal was to study the efficacy and safety of MPH use in children and adolescents diagnosed with ADHD and uncontrolled epilepsy. METHODS We evaluated 24 patients ranging from 7 to 16 years of age who took MPH for 6 months. Inclusion criteria were at least two epileptic seizures in the previous 6 months and a diagnosis of ADHD based on DSM-IV criteria. CONCLUSION Patients were classified according to ADHD subtype as follows: 41.7% inattentive type, 37.5% combined, and 20.8% hyperactive/impulsive type; 58.3% had partial epilepsy and 41.7% generalized epilepsy. There was an overall improvement in ADHD symptoms in 70.8% of patients, and there was no increase in frequency of epileptic seizures in 22 patients (91.6%).
Collapse
Affiliation(s)
- Julio A S Koneski
- Faculty of Medicine of the University of Joinville, Clinica Neurologica, Joinville, SC, Brazil.
| | | | | | | |
Collapse
|
12
|
Conklin HM, Reddick WE, Ashford J, Ogg S, Howard SC, Morris EB, Brown R, Bonner M, Christensen R, Wu S, Xiong X, Khan RB. Long-term efficacy of methylphenidate in enhancing attention regulation, social skills, and academic abilities of childhood cancer survivors. J Clin Oncol 2010; 28:4465-72. [PMID: 20837955 DOI: 10.1200/jco.2010.28.4026] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Methylphenidate (MPH) ameliorates attention problems experienced by some cancer survivors in the short term, but its long-term efficacy is unproven. PATIENTS AND METHODS This study investigates the long-term effectiveness of maintenance doses of MPH in survivors of childhood brain tumors (n = 35) and acute lymphoblastic leukemia (n = 33) participating in a 12-month MPH trial. Measures of attention (Conners' Continuous Performance Test [CPT], Conners' Rating Scales [CRS]), academic abilities (Wechsler Individual Achievement Test [WIAT]), social skills (Social Skills Rating System [SSRS]), and behavioral problems (Child Behavior Checklist [CBCL]) were administered at premedication baseline and at the end of the MPH trial while on medication. A cancer control group composed of patients who were not administered MPH (brain tumor = 31 and acute lymphoblastic leukemia = 23) was assessed on the same measures 12 [corrected] months apart. RESULTS For the MPH group, repeated measures analysis of variance revealed significant improvement in performance on a measure of sustained attention (CPT indices, P < .05); parent, teacher, and self-report ratings of attention (CRS indices, P < .05), and parent ratings of social skills or behavioral problems (SSRS and CBCL indices; P < .05). In contrast, the cancer control group only showed improvement on parent ratings of attention (Conners' Parent Rating Scale indices; P < .05) and social skills (SSRS and CBCL indices; P < .05). There was no significant improvement on the academic measure (WIAT) in either group. CONCLUSION Attention and behavioral benefits of MPH for childhood cancer survivors are maintained across settings over the course of a year. Although academic gains were not identified, MPH may offer benefits in academic areas not assessed.
Collapse
Affiliation(s)
- Heather M Conklin
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Conklin HM, Helton S, Ashford J, Mulhern RK, Reddick WE, Brown R, Bonner M, Jasper BW, Wu S, Xiong X, Khan RB. Predicting methylphenidate response in long-term survivors of childhood cancer: a randomized, double-blind, placebo-controlled, crossover trial. J Pediatr Psychol 2010; 35:144-55. [PMID: 19465537 PMCID: PMC2902831 DOI: 10.1093/jpepsy/jsp044] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 04/22/2009] [Accepted: 04/22/2009] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate the methylphenidate (MPH) response rate among childhood survivors of acute lymphoblastic leukemia (ALL) and brain tumors (BTs) and to identify predictors of positive MPH response. METHODS Cancer survivors (N = 106; BT = 51 and ALL = 55) identified as having attention deficits and learning problems participated in a 3-week, double-blind, crossover trial consisting of placebo, low-dose MPH (0.3 mg/kg), and moderate-dose MPH (0.6 mg/kg). Weekly teacher and parent reports on the Conners' Rating Scales were gathered. RESULTS Following moderate MPH dose, 45.28% of the sample was classified as responders. Findings revealed that more problems endorsed prior to the medication trial on parent and teacher ratings were predictive of positive medication response (p < .05). CONCLUSIONS MPH significantly reduces attention problems in a subset of childhood cancer survivors. Parent and teacher ratings may assist in identifying children most likely to respond to MPH so prescribing may be optimally targeted.
Collapse
Affiliation(s)
- Heather M Conklin
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Conklin HM, Lawford J, Jasper BW, Morris EB, Howard SC, Ogg SW, Wu S, Xiong X, Khan RB. Side effects of methylphenidate in childhood cancer survivors: a randomized placebo-controlled trial. Pediatrics 2009; 124:226-33. [PMID: 19564304 PMCID: PMC2705008 DOI: 10.1542/peds.2008-1855] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate the frequency and severity of side effects of methylphenidate among childhood survivors of acute lymphoblastic leukemia and brain tumors and identify predictors of higher adverse effect levels. METHODS Childhood cancer survivors (N = 103) identified as having attention and learning problems completed a randomized, double-blind, 3-week, home-crossover trial of placebo, low-dose methylphenidate (0.3 mg/kg; 10 mg twice daily maximum) and moderate-dose methylphenidate (0.6 mg/kg; 20 mg twice daily maximum). Caregivers completed the Barkley Side Effects Rating Scale (SERS) at baseline and each week during the medication trial. Siblings of cancer survivors (N = 49) were recruited as a healthy comparison group. RESULTS There was a significantly higher number and severity of symptoms endorsed on the SERS when patients were taking moderate dose compared with placebo or low dose, but not low dose compared with placebo. The number of side effects endorsed on the SERS was significantly lower during all 3 home-crossover weeks (placebo, low dose, moderate dose) when compared with baseline symptom scores. The severity of side effects was also significantly lower, compared with baseline screening, during placebo and low-dose weeks but not moderate-dose weeks. Both the number and severity of symptoms endorsed at baseline were significantly higher for patients compared with siblings. Female gender and lower IQ were associated with higher adverse effect levels. CONCLUSIONS Methylphenidate is generally well tolerated by childhood cancer survivors. There is a subgroup at increased risk for side effects that may need to be closely monitored or prescribed a lower medication dose. The seemingly paradoxical findings of increased "side effects" at baseline must be considered when monitoring side effects and designing clinical trials.
Collapse
Affiliation(s)
- Heather M. Conklin
- Division of Behavioral Medicine, St. Jude Children’s Research Hospital, Memphis, TN
| | - Joanne Lawford
- Division of Behavioral Medicine, St. Jude Children’s Research Hospital, Memphis, TN
| | - Bruce W. Jasper
- Division of Behavioral Medicine, St. Jude Children’s Research Hospital, Memphis, TN
| | - E. Brannon Morris
- Division of Neurology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Scott C. Howard
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Susan W. Ogg
- Division of Behavioral Medicine, St. Jude Children’s Research Hospital, Memphis, TN
| | - Shengjie Wu
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Xiaoping Xiong
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Raja B. Khan
- Department of Neurology, University of Tennessee, Memphis, TN
| |
Collapse
|
15
|
Warren OJ, Leff DR, Athanasiou T, Kennard C, Darzi A. The Neurocognitive Enhancement of Surgeons: An Ethical Perspective. J Surg Res 2009; 152:167-72. [PMID: 18394651 DOI: 10.1016/j.jss.2007.12.761] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 10/25/2007] [Accepted: 12/06/2007] [Indexed: 11/15/2022]
Affiliation(s)
- Oliver J Warren
- Surgical Cognition and Neuro-Imaging Group, Department of BioSurgery and Surgical Technology, Imperial College London, St. Mary's Hospital, London, United Kingdom.
| | | | | | | | | |
Collapse
|
16
|
Jasper BW, Conklin HM, Lawford J, Morris EB, Howard SC, Wu S, Xiong X, Shelso J, Khan RB. Growth effects of methylphenidate among childhood cancer survivors: a 12-month case-matched open-label study. Pediatr Blood Cancer 2009; 52:39-43. [PMID: 18855893 PMCID: PMC2585147 DOI: 10.1002/pbc.21770] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND To investigate the effect of stimulant medication [methylphenidate (MPH)] on growth patterns among survivors of childhood cancer (acute lymphoblastic leukemia or brain tumor). PROCEDURE Using a case-matched comparison design, childhood cancer survivors participating in a 12-month open-label MPH trial (n = 51) were compared with childhood cancer survivors not taking MPH (n = 51). Measures of body mass index (BMI), height, and weight were obtained at hospital visits and corrected for gender and age using Centers for Disease Control normative data. RESULTS Significant deceleration of BMI and weight, but not height, was observed during the 12-month MPH trial for those children taking MPH. CONCLUSIONS Childhood cancer survivors taking MPH experience significant, though modest, deceleration of BMI and weight across the first year of MPH intervention. The absence of height deceleration, and the presence of only modest BMI and weight deceleration, suggests that MPH is reasonably well tolerated by childhood cancer survivors with respect to growth. Such findings are encouraging in light of increasing evidence that MPH mitigates some of the cognitive late-effects of cancer treatments. Nevertheless, on a case-by-case basis, clinicians should balance the intended benefits of MPH with potential growth effects in this vulnerable population.
Collapse
Affiliation(s)
- Bruce W. Jasper
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis TN, USA
| | - Heather M. Conklin
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis TN, USA
| | - Joanne Lawford
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis TN, USA
| | - E. Brannon Morris
- Division of Neurology, St. Jude Children's Research Hospital, Memphis TN, USA
| | - Scott C. Howard
- Department of Oncology, St. Jude Children's Research Hospital, Memphis TN, USA
| | - Shengjie Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis TN, USA
| | - Xiaoping Xiong
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis TN, USA
| | - John Shelso
- Division of Endocrinology, St. Jude Children's Research Hospital, Memphis TN, USA
| | - Raja B. Khan
- Department of Neurology, University of Tennessee, Memphis TN, USA
| |
Collapse
|
17
|
Baptista-Neto L, Dodds A, Rao S, Whitney J, Torres A, Gonzalez-Heydrich J. An expert opinion on methylphenidate treatment for attention deficit hyperactivity disorder in pediatric patients with epilepsy. Expert Opin Investig Drugs 2008; 17:77-84. [PMID: 18095920 DOI: 10.1517/13543784.17.1.77] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Methylphenidate (MPH) is one of the most commonly prescribed medications to treat attention deficit hyperactivity disorder (ADHD). Despite the elevated rates of ADHD in children with epilepsy, few studies have examined the use of MPH in this population. Case reports have warned about new-onset seizures in patients treated with MPH, and drug-drug interactions between MPH and antiepileptic drugs (AEDs), as well as antidepressants. However, retrospective chart reviews, open-label trials and controlled trials of MPH in patients with epilepsy and ADHD have noted significant improvements in ADHD symptoms without an exacerbation of seizures or an adverse effect on AED serum levels. This paper reviews the chemistry and mechanisms of action of MPH, as well as preclinical, premarketing clinical trials and postmarketing data relevant to its use in patients with ADHD and epilepsy.
Collapse
Affiliation(s)
- Lourival Baptista-Neto
- Children's Hospital of Boston, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Lim YS, Sim JY, Son JW, Kim WS. Brain wave results in children with attention deficit hyperactivity disorder and treatment result with central nervous system stimulants. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.12.1324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Young Su Lim
- Department of Pediatrics, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Ji Yun Sim
- Department of Pediatrics, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Jung-Woo Son
- Department of Neuropsychiatry, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Won Seop Kim
- Department of Pediatrics, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| |
Collapse
|
19
|
Rosa-Neto P, Lou HC, Cumming P, Pryds O, Karrebaek H, Lunding J, Gjedde A. Methylphenidate-evoked changes in striatal dopamine correlate with inattention and impulsivity in adolescents with attention deficit hyperactivity disorder. Neuroimage 2005; 25:868-76. [PMID: 15808987 DOI: 10.1016/j.neuroimage.2004.11.031] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Revised: 11/22/2004] [Accepted: 11/29/2004] [Indexed: 11/24/2022] Open
Abstract
Abnormal central dopamine (DA) neurotransmission has been implicated in the impulsivity, inattention, and hyperactivity of attention deficit hyperactivity disorder (ADHD). We hypothesized that a pharmacological challenge with methylphenidate (MP) at a therapeutic dose increases extracellular DA concentrations in proportion to the severity of these specific ADHD symptoms. To test this hypothesis, we measured by PET the effect of acute challenge with MP on the availability of striatal binding sites for [11C]raclopride (pB), an index of altered interstitial DA concentration, in nine unmedicated adolescents (1 female, 8 males; age 13.7 +/- 1.8 years) with a current diagnosis of ADHD. We estimated the pB of [11C]raclopride for brain dopamine D2/3 receptors first in a baseline resting condition, and again after an acute challenge with MP (0.3 mg/kg, p.o.), and calculated the percentage change in (%DeltapB) in left and right striatum. On another day, measurements of impulsivity and inattention were performed using a computerized continuous performance test. There was a significant correlation between the magnitude of %DeltapB in the right striatum and the severity of inattention and impulsivity. MP-evoked %DeltapB correlated with standard scores for impulse control (r = 0.68; P = 0.02), attention (r = 0.81; P = 0.005), information processing (r = 0.66; P = 0.02), and consistency of attention, or variability (r = 0.60; P = 0.04). In conclusion, the results link inattention and impulsivity with sensitivity of brain DA receptor availability to an MP challenge, corroborating the hypothesis that MP serves to potentiate decreased DA neurotransmission in ADHD.
Collapse
Affiliation(s)
- Pedro Rosa-Neto
- Center for Functionally Integrative Neuroscience, Aarhus University and PET Center, Aarhus University Hospitals, 44 Nørrebrogade, Building 10, Aarhus C 8000, Denmark
| | | | | | | | | | | | | |
Collapse
|
20
|
Butler RW, Mulhern RK. Neurocognitive Interventions for Children and Adolescents Surviving Cancer. J Pediatr Psychol 2005; 30:65-78. [PMID: 15610986 DOI: 10.1093/jpepsy/jsi017] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is well recognized that many cures for childhood leukemia and brain tumors entail some relatively permanent neurocognitive and psychological costs to the patient and family. As cure rates have improved over the past three decades, increasing efforts have been directed toward reducing treatment-related late effects. OBJECTIVE The particular focus of this review will be on interventions for the neuropsychological late effects associated with the treatment of acute lymphoblastic leukemia (ALL) and malignant brain tumors. SUMMARY We will first briefly review current approaches to the medical treatment of ALL and brain tumors to provide an appreciation of potential sources of brain injury. We will then summarize the existing literature on types of neuropsychological deficits found among survivors, with special attention to variables that place some children at greater risk. Then, there will be a discussion of approaches to intervention for these deficits-specifically, cognitive remediation, pharmacology, and ecological alterations in the classroom. Finally, we will present directions for future research in the field.
Collapse
Affiliation(s)
- Robert W Butler
- Oregon Health Science University, Portland, Oregon, 97239, USA.
| | | |
Collapse
|
21
|
Mulhern RK, Khan RB, Kaplan S, Helton S, Christensen R, Bonner M, Brown R, Xiong X, Wu S, Gururangan S, Reddick WE. Short-Term Efficacy of Methylphenidate: A Randomized, Double-Blind, Placebo-Controlled Trial Among Survivors of Childhood Cancer. J Clin Oncol 2004; 22:4795-803. [PMID: 15570081 DOI: 10.1200/jco.2004.04.128] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeChildren surviving acute lymphoblastic leukemia (ALL) and malignant brain tumors (BTs) have a higher incidence of attention and learning problems in school than do their healthy peers. The present study tests the hypothesis that the psychostimulant methylphenidate (MPH) improves cognitive and social functioning among these patients.Patients and MethodsWe report on 83 long-term survivors of ALL and BT identified as having attentional deficits on behavioral testing and parent or teacher report, and problems with academic achievement. The 47 male and 36 female patients ranged from 0.6 to 14.3 years (median, 5.4 years) of age at diagnosis and 6.7 to 17.9 years (median, 11.9 years) of age at participation. The patients (40 ALL, 43 BT) participated in a randomized, double-blind, 3-week home cross-over trial of placebo (bid), low-dose MPH (0.3 mg/kg; maximum dose, 10 mg bid), and moderate-dose MPH (0.6 mg/kg; maximum dose, 20 mg bid). The primary end points were weekly teacher and parent reports on the Conners’ Rating Scales and Social Skills Rating System.ResultsCompared to placebo, significant improvement with MPH was reported by teachers and parents on the Conners’ Rating Scales and by teachers on the Social Skills Rating System. However, no consistent advantage of moderate dose over low dose was observed. Of those participating, 66 (79.5%) of the 83 patients continued on best clinical management.ConclusionTreatment with MPH can at least temporarily reduce some attentional and social deficits among survivors of childhood ALL and BT. Long-term follow-up will reveal those subsets of patients who are more likely to benefit from MPH.
Collapse
Affiliation(s)
- Raymond K Mulhern
- Division of Behavioral Medicine, Department of Hematology/Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Advances in cognitive neuroscience and neuropharmacology are yielding exciting treatments for neurologic diseases. Many of these treatments are also likely to have uses for people without disease. Here, I review the ways in which medicine might make bodies and brains function better by modulating motor, cognitive, and affective systems. These potential "quality of life" interventions raise ethical concerns, some related to the individual and others related to society. Despite these concerns, I argue that major restraints on the development of cosmetic neurology are not likely. Neurologists and other clinicians are likely to encounter patient-consumers who view physicians as gatekeepers in their own pursuit of happiness.
Collapse
Affiliation(s)
- Anjan Chatterjee
- Department of Neurology and the Center for Cognitive Neuroscience, The University of Pennsylvania, 3 West Gates, 3400 Spruce St., Philadelphia, PA 19104, USA.
| |
Collapse
|
23
|
Mulhern RK, Merchant TE, Gajjar A, Reddick WE, Kun LE. Late neurocognitive sequelae in survivors of brain tumours in childhood. Lancet Oncol 2004; 5:399-408. [PMID: 15231246 DOI: 10.1016/s1470-2045(04)01507-4] [Citation(s) in RCA: 603] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As survival among children treated for cancer continues to improve, more attention is being focussed on the late effects of cancer treatment. In children treated for brain tumours, chronic neurocognitive effects are especially challenging. Deficits in cognitive development have been described most thoroughly among children treated for posterior-fossa tumours, specifically medulloblastomas and ependymomas, which account for about 30% of all newly diagnosed cases of brain tumours in children. Most children who have survived brain tumours have required surgical resection and focal or craniospinal radiotherapy (irradiation of the entire subarachnoid volume of the brain and spine), with or without systemic chemotherapy. Historically, intelligence quotient (IQ) scores have provided a benchmark against which to measure changes in cognitive development after treatment. Observed declines in IQ are most likely a result of failure to learn at a rate that is appropriate for the age of the child, rather than from a loss of previously acquired knowledge. The rate of IQ decline is associated with a several risk factors, including younger age at time of treatment, longer time since treatment, female sex, as well as clinical variables such as hydrocephalus, use of radiotherapy and radiotherapy dose, and the volume of the brain that received treatment. Loss of cerebral white matter and failure to develop white matter at a rate appropriate to the developmental stage of the child could partly account for changes in IQ score. Technical advances in radiotherapy hold promise for lowering the frequency of neurocognitive sequelae. Further efforts to limit neurocognitive sequelae have included design of clinical trials to test the effectiveness of cognitive, behavioural, and pharmacological interventions.
Collapse
Affiliation(s)
- Raymond K Mulhern
- Division of Behavioral Medicine, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
| | | | | | | | | |
Collapse
|
24
|
Mulhern RK, Butler RW. Neurocognitive sequelae of childhood cancers and their treatment. ACTA ACUST UNITED AC 2004; 7:1-14; discussion 15-6. [PMID: 14744668 DOI: 10.1080/13638490310001655528] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Raymond K Mulhern
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, 332 North Lauderdale, Memphis, TN 38105, USA.
| | | |
Collapse
|
25
|
Lin Z, Uhl GR. Human dopamine transporter gene variation: effects of protein coding variants V55A and V382A on expression and uptake activities. THE PHARMACOGENOMICS JOURNAL 2004; 3:159-68. [PMID: 12815364 DOI: 10.1038/sj.tpj.6500169] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The human dopamine transporter (DAT, SLC6A3) is an important 15 exon gene for dopamine neurotransmission and dopamine recycling. Common exon 15 variable number tandem repeat variants can be associated with attention deficit/hyperactivity disorder. Rarer single nucleotide polymorphisms produce missense variants including V55A and V382A. We now report studies of the functional influences of these DAT protein-coding variants. In COS cell transient-expression assays, V382A displays about half of the dopamine uptake velocity Vmax and cocaine analog binding Bmax values of wildtype DAT. V382A lowers dopamine's potency in inhibiting cocaine analog binding by six-fold. Cells expressing V382A or mixtures of V382A and wildtype DAT both display reduced plasma membrane and increased perinuclear expression, consistent with dominant effects of V328A on expression. V55A expresses normally but reveals a 1.7-fold-lower Km for dopamine uptake. Individuals with these human DAT protein variants could display altered dopamine systems.
Collapse
Affiliation(s)
- Zhicheng Lin
- Molecular Neurobiology Branch, NIDA-IRP, NIH, Nathan Shock Drive, Baltimore, MD, USA
| | | |
Collapse
|
26
|
Lemay JF, Herbert AR, Dewey DM, Innes AM. A rational approach to the child with mental retardation for the paediatrician. Paediatr Child Health 2003; 8:345-56. [PMID: 20052328 PMCID: PMC2795455 DOI: 10.1093/pch/8.6.345] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
Mental Retardation (MR) is a problem encountered in almost all paediatric clinical settings. The assessment of a child with MR is a common diagnostic and management dilemma for paediatricians. The field of MR research is currently in a state of flux regarding not just our understanding of the condition, but also in the language and the processes we use in naming, defining and describing MR. This article will provide a better understanding and a rational approach toward MR. Prevalence rates for MR are variable in the literature and may be attributable to the variation in major classification systems and the diversity in study operation definitions and methodologies. Etiologies of MR are diverse and include many different influences. MR most often presents during infancy or preschool years as developmental delay. There is no universally accepted approach to the etiological work-up of mental retardation. The number of medical conditions associated with MR that are completely treatable by medical means remains small. The paediatrician plays a key role establishing short and long term treatment goals, as well as providing support to families who have children with MR.
Collapse
Affiliation(s)
- Jean-François Lemay
- University of Calgary, Developmental Pediatrics, Alberta Children’s Hospital, Calgary, Alberta
| | - Anthony R Herbert
- Registrar in Pediatrics, Mater Children’s Hospital, Brisbane, Australia
| | - Deborah M Dewey
- University of Calgary, Department of Pediatrics and Behavioural Research Unit, Alberta Children’s Hospital, Calgary
| | - A Micheil Innes
- University of Calgary, Alberta Children’s Hospital, Calgary, Alberta
| |
Collapse
|
27
|
Gross-Tsur V, Shalev RS, Badihi N, Manor O. Efficacy of methylphenidate in patients with cerebral palsy and attention-deficit hyperactivity disorder (ADHD). J Child Neurol 2002; 17:863-6. [PMID: 12593456 DOI: 10.1177/08830738020170121401] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our objective was to study the short-term efficacy and safety of methylphenidate in patients with the dual diagnosis of cerebral palsy and attention-deficit hyperactivity disorder (ADHD). Twenty-nine patients (8.0 +/- 4.0 years old) with cerebral palsy and ADHD completed the study. In a prospective, crossover, double-blind paradigm, patients were treated with methylphenidate or placebo, each for 4 weeks. Parents and teachers completed a modified Abbreviated Conners' Rating Scale at the beginning of the study and the end of the first and second months of treatment with methylphenidate or placebo. Parents were contacted weekly to report side effects. Methylphenidate treatment, as assessed by teachers' ratings, resulted in a significant improvement in ADHD symptomatology (t = 2.29, df = 27, P < .05); however, a trend for improvement was noted only on the parents' ratings. After the conclusion of the study, 12 patients continued methylphenidate for 20 +/- 10 months. Side effects were minimal, with the exception of transient hallucinations in one patient. In children with cerebral palsy and ADHD, methylphenidate is effective, rendering it a valuable adjunct to their overall medical therapy.
Collapse
Affiliation(s)
- Varda Gross-Tsur
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
| | | | | | | |
Collapse
|