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Campbell BP, Turk KW, Budson AE. The major challenges with pharmacologic management of chronic traumatic encephalopathy. Expert Rev Neurother 2024:1-5. [PMID: 39099111 DOI: 10.1080/14737175.2024.2387264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/29/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Brendan P Campbell
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Alzheimer's Disease Research Center, Boston University, Boston, MA, USA
| | - Katherine W Turk
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Alzheimer's Disease Research Center, Boston University, Boston, MA, USA
| | - Andrew E Budson
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Alzheimer's Disease Research Center, Boston University, Boston, MA, USA
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2
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Müller T, Riederer P, Kuhn W. Aminoadamantanes: from treatment of Parkinson's and Alzheimer's disease to symptom amelioration of long COVID-19 syndrome? Expert Rev Clin Pharmacol 2023; 16:101-107. [PMID: 36726198 DOI: 10.1080/17512433.2023.2176301] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aminoadamantanes amantadine and memantine are well known. They mainly act as N-methyl-D-aspartate antagonists. AREAS COVERED The antiviral drug amantadine moderately ameliorates impaired motor behavior in patients with Parkinson's disease. Memantine provides beneficial effects on memory function in patients with advanced Alzheimer's disease already treated with acetylcholine esterase inhibitors. Both compounds counteract impaired monoamine neurotransmission with associated symptoms, such as depression. They improve vigilance, lack of attention and concentration, fatigue syndromes according to clinical findings in patients with chronic neurodegenerative processes. Their extrasynaptic N-methyl-D-Aspartate receptor blockade weakens a prolonged influx of Ca2+ ions as the main responsible components of neuronal excitotoxicity. This causes neuronal dying and associated functional deficits. EXPERT OPINION We suggest aminoadamantanes as future therapies for amelioration of short- and long-term consequences of a COVID 19 infection. Particularly the extended-release amantadine formulations will be suitable. They showed better clinical efficacy compared with the conventional available compounds. Amantadine may particularly be suitable for amelioration of fatigue or chronic exhaustion, memantine for improvement of cognitive deficits. Clinical research in patients, who are affected by the short- and long-term consequences of a COVID 19 infection, is warranted to confirm these still hypothetical putative beneficial effects of aminoadamantanes.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weissensee, Gartenstr. 1, 13088, Berlin, Germany
| | - Peter Riederer
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Füchsleinstrasse 15, 97080, Würzburg, Germany
| | - Wilfried Kuhn
- Department of Neurology, Leopoldina Hospital Schweinfurt, Gustav Adolf Str. 8, 97422, Schweinfurt, Germany
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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.
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4
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Coris EE, Moran B, Sneed K, Del Rossi G, Bindas B, Mehta S, Narducci D. Stimulant Therapy Utilization for Neurocognitive Deficits in Mild Traumatic Brain Injury. Sports Health 2021; 14:538-548. [PMID: 34292098 DOI: 10.1177/19417381211031842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT There are 3.8 million mild traumatic brain injuries (mTBIs) that occur each year in the United States. Many are left with prolonged life-altering neurocognitive deficits, including difficulties in attention, concentration, mental fatigue, and distractibility. With extensive data on the safety and efficacy of stimulant medications in treating attention deficit, concentration difficulties and distractibility seen with attention deficit disorder, it is not surprising that interest continues regarding the application of stimulant medications for the persistent neurocognitive deficits in some mTBIs. EVIDENCE ACQUISITION Studies were extracted from PubMed based on the topics of neurocognitive impairment, mTBI, stimulant use in mTBI, stimulants, and the association between attention deficit/hyperactivity disorder and mTBI. The search criteria included a date range of 1999 to 2020 in the English language. STUDY DESIGN Literature review. LEVEL OF EVIDENCE Level 4. RESULTS Currently, there is very limited literature, and no guidelines for evaluating the use of stimulant medication for the treatment of prolonged neurocognitive impairments due to mTBI. However, a limited number of studies have demonstrated efficacy and safety of stimulants in the treatment of neurocognitive sequelae of mTBI in the adult, pediatric, military, and athletic populations. CONCLUSION There is limited evidence to suggest stimulant medication may be beneficial in patients with mTBI with persistent neurocognitive symtpoms. The decision to utilize stimulant medication for mTBI patients remains physician and patient preference dependent. Given the limited encouraging data currently available, physicians may consider stimulant medication in appropriate patients to facilitate the recovery of prolonged neurocognitive deficits, while remaining cognizant of potential adverse effects.
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Affiliation(s)
- Eric E Coris
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida.,USF Morsani College of Medicine, Department of Orthopedics and Sports Medicine, Tampa, Florida
| | - Byron Moran
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida.,USF Morsani College of Medicine, Department of Orthopedics and Sports Medicine, Tampa, Florida
| | | | - Gianluca Del Rossi
- USF Morsani College of Medicine, Department of Orthopedics and Sports Medicine, Tampa, Florida
| | - Bradford Bindas
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida
| | - Shaan Mehta
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida
| | - Dusty Narducci
- USF Morsani College of Medicine, Department of Family Medicine, Tampa, Florida.,USF Morsani College of Medicine, Department of Orthopedics and Sports Medicine, Tampa, Florida
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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.
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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
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Zhang L, Levenson CW, Salazar VC, McCarthy DM, Biederman J, Zafonte R, Bhide PG. Repetitive Mild Traumatic Brain Injury in a Perinatal Nicotine Exposure Mouse Model of Attention Deficit Hyperactivity Disorder. Dev Neurosci 2021; 43:63-72. [PMID: 33849015 DOI: 10.1159/000515198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/11/2021] [Indexed: 11/19/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) increases the risk for concussion or mild traumatic brain injury (mTBI). At the same time, recommendations for the management of ADHD include participation in sports and other organized physical activities, including those that carry an increased risk of mTBI. Very little work has been done to determine the extent to which untreated ADHD adversely impacts behavioral outcomes of repeated mild concussions. Here, we used a perinatal nicotine exposure (PNE) mouse model of ADHD combined with a closed-head, repetitive mTBI model. The PNE mouse model carries significant construct, face, and predictive validity as a preclinical model of ADHD. Two-month-old PNE and control mice were subjected to closed-head repetitive mTBI or sham procedure once daily for 5 days. Object-based attention, novel object recognition memory, spatial working memory, and depression-like behavior were analyzed 1 day and 2 weeks following repeated mTBI. Consistent with our previous reports, mice in the PNE group showed significant deficits in object-based attention and working memory prior to mTBI. These deficits persisted following the repeated mTBI. Repeated mTBI produced a transient attention deficit in the control group but did not exacerbate the attention deficit that is characteristic of the PNE group. Although neither PNE nor repetitive mTBI alone influenced immobility in the tail suspension test, when PNE mice were subjected to mTBI, there was a transient increase in this measurement suggesting a synergistic effect of ADHD and mTBI on depression-like behavior. Thus, our data using the PNE mouse model suggest that ADHD may be a risk factor for transient depression following repeated mTBI and that repeated mTBI may be a risk factor for transient attention deficit.
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Affiliation(s)
- Lin Zhang
- Center for Brain Repair, Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Cathy W Levenson
- Center for Brain Repair, Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Valentina Cea Salazar
- Center for Brain Repair, Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Deirdre M McCarthy
- Center for Brain Repair, Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Joseph Biederman
- Pediatric Psychopharmacology, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General hospital, Brigham and Women's Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Pradeep G Bhide
- Center for Brain Repair, Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
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Traumatic brain injury and methamphetamine: A double-hit neurological insult. J Neurol Sci 2020; 411:116711. [DOI: 10.1016/j.jns.2020.116711] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/27/2019] [Accepted: 01/29/2020] [Indexed: 11/17/2022]
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8
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Levin H, Troyanskaya M, Petrie J, Wilde EA, Hunter JV, Abildskov TJ, Scheibel RS. Methylphenidate Treatment of Cognitive Dysfunction in Adults After Mild to Moderate Traumatic Brain Injury: Rationale, Efficacy, and Neural Mechanisms. Front Neurol 2019; 10:925. [PMID: 31572283 PMCID: PMC6751302 DOI: 10.3389/fneur.2019.00925] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/09/2019] [Indexed: 11/13/2022] Open
Abstract
Positive effects of methylphenidate (MPH) on attention and cognitive processing speed have been reported in studies of patients with moderate to severe traumatic brain injury (TBI). Studies which have acquired functional brain imaging before and while using MPH have also found alteration of brain activation while performing a cognitive task; in some studies, this alteration of activation in selective brain regions was also related to improved performance on cognitive tests administered outside of the scanning environment. Enhanced cognitive performance has been reported after single doses of MPH and after daily treatment over durations of up to and exceeding 1 month. Preclinical research and both positron emission tomography and single photon emission tomography of humans have shown that MPH increases extracellular dopamine and norepinephrine; the dose effects of MPH have an inverted U-shaped function where high doses may cause insomnia, nervousness, and increased heart rate among other symptoms and impair cognitive performance, whereas too low a dose fails to improve cognitive performance. In the past 5 years, small clinical trials, and experimental pilot studies have found therapeutic effects of single and repeated low doses of MPH in patients with mild TBI who reported cognitive dysfunction. This literature also suggests that MPH may interact with concurrent cognitive interventions to enhance their effects. This focused review will critically evaluate the recent literature on MPH effects on cognitive dysfunction after mild to moderate TBI. To elucidate the neural mechanisms of MPH effects, this review will also include recent imaging research, preclinical, and experimental human studies.
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Affiliation(s)
- Harvey Levin
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX, United States
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Maya Troyanskaya
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX, United States
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - JoAnn Petrie
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Elisabeth A. Wilde
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX, United States
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | - Jill V. Hunter
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Tracy J. Abildskov
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Randall S. Scheibel
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX, United States
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
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Kapadia M, Scheid A, Fine E, Zoffness R. Review of the Management of Pediatric Post-Concussion Syndrome-a Multi-Disciplinary, Individualized Approach. Curr Rev Musculoskelet Med 2019; 12:57-66. [PMID: 30758705 PMCID: PMC6388574 DOI: 10.1007/s12178-019-09533-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Post-concussion syndrome (PCS), when the patient's concussion symptoms last longer than 4-6 weeks, affects 10-30% of concussion patients. PCS presents a significant source of morbidity to patients and a management challenge to providers. In this review, we present the current evidence and best management approaches for pediatric PCS. RECENT FINDINGS There is limited high-quality evidence in pediatric PCS. There is some evidence supporting pharmaceutical management of post-traumatic headaches, cognitive symptoms, and emotional symptoms. Vestibular-ocular dysfunction should be evaluated and managed appropriately. Neuropsychological recovery is expected, but requires appropriate attention to Return to Learn. Emotional symptoms are common in PCS and the evidence supports treatment with cognitive behavioral therapy. PCS presents a unique therapeutic challenge affecting multiple domains for patients-physical, sleep, cognitive, and emotional. Successful management of PCS requires a multi-disciplinary and individualized approach. There remains a significant need for further research, specifically looking into the outcomes and effective interventions in pediatric PCS.
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Affiliation(s)
- Mitul Kapadia
- Division of Pediatric Rehabilitation Medicine, Mission Hall, UCSF Benioff Children's Hospital, Box 0110, 550 16th Street, 4th Floor, San Francisco, CA, 34143, USA.
- University of California, San Francisco, CA, USA.
| | - Alison Scheid
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
| | - Eric Fine
- Department of Neurology, University of California, San Francisco, CA, USA
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Retzer A, Turner GM, Slade A, Kyte D, McMullan C, Jones L, Belli A, Calvert M. Electronic patient reported outcomes to support care of patients with traumatic brain injury: PRiORiTy study qualitative protocol. BMJ Open 2019; 9:e024617. [PMID: 30782736 PMCID: PMC6352873 DOI: 10.1136/bmjopen-2018-024617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/11/2018] [Accepted: 12/07/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) represents a major health and socioeconomic problem internationally. The expansive nature of injuries results in a heterogeneous population. The degree and type of long-term impacts following TBI and improvement following injury are highly variable. The use of electronic Patient Reported Outcomes Measures (ePROMs) could help identify residual impacts of TBI and support patient management and care. The Patient Reported Outcomes Research in Trauma study is a qualitative study exploring the long-term symptoms and impacts that are experienced by those with TBI and the potential utility of an ePROM platform to collect real-time information on patient symptoms and quality of life to inform treatment and identify support needs. METHODS AND ANALYSIS Semi-structured telephone and face-to-face interviews will be conducted with approximately 30-40 individuals recruited from five groups: (1) people with TBI; (2) carers and relatives of individuals with TBI; (3) TBI healthcare professionals; (4) researchers and (5) third sector staff members and volunteers working with those with TBI. Data will be analysed using directed thematic analysis employing an iterative coding frame that will be modified as analysis progresses. Intercoder triangulation will be employed to enhance credibility. ETHICS AND DISSEMINATION This study was approved by the West Midlands-Black Country Research Ethics Committee (Ref: 18/WM/0033). Findings will be disseminated via conference presentations, peer-reviewed journals, social media (@CPROR_UoB; http://www.birmingham.ac.uk/cpror) and the National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre.
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Affiliation(s)
- Ameeta Retzer
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Grace M Turner
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Anita Slade
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Laura Jones
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Antonio Belli
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham
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Iaccarino MA, Fitzgerald M, Pulli A, Woodworth KY, Spencer TJ, Zafonte R, Biederman J. Sport concussion and attention deficit hyperactivity disorder in student athletes: A cohort study. Neurol Clin Pract 2018; 8:403-411. [PMID: 30564494 DOI: 10.1212/cpj.0000000000000525] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/07/2018] [Indexed: 12/12/2022]
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is associated with impulsive behavior and inattention, making it a potential risk factor for sport-related concussion (SRC). The objectives of this study were to determine whether ADHD is an antecedent risk factor for SRC and whether ADHD complicates recovery from SRC in youth athletes. Methods Student athletes with a history of SRC were evaluated for the presence of ADHD using diagnostic interview and to determine whether ADHD symptoms began before or after SRC. Concussion-specific measures of concussive symptoms and cognitive function were compared in SRC + ADHD and SRC + No ADHD groups to assess SRC recovery between groups. Results ADHD was overrepresented in youth with SRC compared with population rates. ADHD was found to be an antecedent risk factor for SRC, with age at ADHD onset earlier than the date of SRC. Student athletes with SRC and ADHD reported more concussive symptoms compared with athletes without ADHD and were more likely to have a history of greater than one concussion. Conclusions The results of this study support our hypothesis that ADHD is an antecedent risk factor for SRC and may contribute to a more complicated course of recovery from SRC. Future research should focus on determining whether screening, diagnosis, and treating ADHD in youth athletes may prevent SRC. Providers that care for youth athletes with ADHD should be aware of the vulnerabilities of this population toward SRC and its complications.
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Affiliation(s)
- Mary A Iaccarino
- Department of Physical Medicine and Rehabilitation (MAI, RZ), Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital; Department of Physical Medicine and Rehabilitation (RZ), Brigham and Women's Hospital; Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD (MF, AP, KYW, TJS, JB), Massachusetts General Hospital; and Department of Psychiatry (TJS, JB), Harvard Medical School, Boston, MA
| | - Maura Fitzgerald
- Department of Physical Medicine and Rehabilitation (MAI, RZ), Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital; Department of Physical Medicine and Rehabilitation (RZ), Brigham and Women's Hospital; Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD (MF, AP, KYW, TJS, JB), Massachusetts General Hospital; and Department of Psychiatry (TJS, JB), Harvard Medical School, Boston, MA
| | - Alexa Pulli
- Department of Physical Medicine and Rehabilitation (MAI, RZ), Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital; Department of Physical Medicine and Rehabilitation (RZ), Brigham and Women's Hospital; Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD (MF, AP, KYW, TJS, JB), Massachusetts General Hospital; and Department of Psychiatry (TJS, JB), Harvard Medical School, Boston, MA
| | - K Yvonne Woodworth
- Department of Physical Medicine and Rehabilitation (MAI, RZ), Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital; Department of Physical Medicine and Rehabilitation (RZ), Brigham and Women's Hospital; Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD (MF, AP, KYW, TJS, JB), Massachusetts General Hospital; and Department of Psychiatry (TJS, JB), Harvard Medical School, Boston, MA
| | - Thomas J Spencer
- Department of Physical Medicine and Rehabilitation (MAI, RZ), Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital; Department of Physical Medicine and Rehabilitation (RZ), Brigham and Women's Hospital; Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD (MF, AP, KYW, TJS, JB), Massachusetts General Hospital; and Department of Psychiatry (TJS, JB), Harvard Medical School, Boston, MA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation (MAI, RZ), Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital; Department of Physical Medicine and Rehabilitation (RZ), Brigham and Women's Hospital; Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD (MF, AP, KYW, TJS, JB), Massachusetts General Hospital; and Department of Psychiatry (TJS, JB), Harvard Medical School, Boston, MA
| | - Joseph Biederman
- Department of Physical Medicine and Rehabilitation (MAI, RZ), Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital; Department of Physical Medicine and Rehabilitation (RZ), Brigham and Women's Hospital; Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD (MF, AP, KYW, TJS, JB), Massachusetts General Hospital; and Department of Psychiatry (TJS, JB), Harvard Medical School, Boston, MA
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