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Methylphenidate improves cognitive function during rehabilitation after TBI
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MARCH 2009 VOL 5 NO 3 NATURE CLINICAL PRACTICE NEUROLOGY 125 www.nature.com/clinicalpractice/neuro TGF-β levels might predict CCH after subarachnoid hemorrhage Chronic communicating hydrocephalus (CCH) is a common complication of subarachnoid hemorrhage, and results from fibrosis in the subarachnoid space blocking the drainage of cerebrospinal fluid (CSF). Transforming growth factor (TGF)-β1 and TGF-β2 have been impli- cated in the development of CCH in rodent models; a UK study has now found that high TGF-β levels predict the development of CCH after subarachnoid hemorrhage in humans. Douglas et al. measured TGF-β levels in CSF collected from twenty patients with acute hydrocephalus after subarachnoid hemorrhage, and compared these levels with those from seven patients with chronic nonhemorrhagic hydrocephalus. Posthemorrhagic patients had significantly higher levels of total and active TGF-β1 and TGF-β2 than did nonhemorrhagic patients. Total TGF-β levels peaked 1–5 days after hemorrhage, and remained elevated com- pared with control values at all subsequent time points. Comparison with the trend in albumin levels ruled out rebleeding as a cause of consistently elevated TGF-β levels. In total, 10 patients with subarachnoid hemorrhage went on to develop CCH, and these patients had significantly higher TGF-β1 and TGF-β2 levels over days 1–9 after hemorrhage than those who did not develop CCH. The authors conclude that elevated TGF-β levels in the CSF after subarachnoid hemor- rhage are potential predictors of CCH and may indicate a need for early therapeutic intervention. Original article Douglas MR et al. (2008) High CSF TGFβ levels after subarachnoid haemorrhage: association with chronic communicating hydrocephalus. J Neurol Neurosurg Psychiatry [doi:10.1136/jnnp.2008.155671] Methylphenidate improves cognitive function during rehabilitation after TBI Methylphenidate, a neural stimulant often used to treat attention-deficit hyperactivity disorder, can help to improve attention in patients who are undergoing rehabilitation after traumatic brain injury (TBI), a new study suggests. Willmott and Ponsford assessed the efficacy of methylphenidate in improving different fea- tures of attention (sustained attention, working memory, strategic control, and speed of pro- cessing) in 40 patients with moderate to severe TBI (mean time since injury 68 days). Following an initial assessment, patients were randomly assigned to receive 3 days of methylphenidate at a dose of 0.3 mg/kg (benchmark dose) and 3 days of placebo over a 2-week inpatient rehabilitation period. Attention was measured during each therapy session by a battery of tests, and a behavioral rating scale. Compared with placebo administration, treatment with methylphenidate was associ- ated with a significant improvement in speed of information processing. The greatest response to the study drug was observed in the patients with the greatest injury severity and slowest baseline processing speed. Patients’ perfor- mance in the domains of working memory and strategic control did not show notable improvement when methylphenidate was received rather than placebo. The authors propose further trials to assess the benefits of methylphenidate treatment over an extended duration as an adjunct to rehabilitation therapy for patients with TBI. Original article Willmott C and Ponsford J (2008) Efficacy of methylphenidate in the rehabilitation of attention following traumatic brain injury: a randomized, crossover, double-blind, placebo controlled inpatient trial. J Neurol Neurosurg Psychiatry [doi:10.1136/jnnp.2008.159632] RESEARCH HIGHLIGHTS © 2009 Macmillan Publishers Limited. All rights reserved
Transcript of Methylphenidate improves cognitive function during rehabilitation after TBI
MARCH 2009 VOL 5 NO 3 NATURE CLINICAL PRACTICE NEUROLOGY 125
www.nature.com/clinicalpractice/neuro
TGF-β levels might predict CCH after subarachnoid hemorrhage
Chronic communicating hydrocephalus (CCH) is a common complication of subarachnoid hemorrhage, and results from fibrosis in the subarachnoid space blocking the drainage of cerebrospinal fluid (CSF). Transforming growth factor (TGF)-β1 and TGF-β2 have been impli-cated in the development of CCH in rodent models; a UK study has now found that high TGF-β levels predict the development of CCH after subarachnoid hemorrhage in humans.
Douglas et al. measured TGF-β levels in CSF collected from twenty patients with acute hydrocephalus after sub arachnoid hemor rhage, and compared these levels with those from seven patients with chronic non hemorrhagic hydro cephalus. Post hemorrhagic patients had significantly higher levels of total and active TGF-β1 and TGF-β2 than did non hemorrhagic patients. Total TGF-β levels peaked 1–5 days after hemorrhage, and remained elevated com-pared with control values at all sub sequent time points. Comparison with the trend in albumin levels ruled out rebleeding as a cause of consis tently elevated TGF-β levels. In total, 10 patients with subarachnoid hemor rhage went on to develop CCH, and these patients had significantly higher TGF-β1 and TGF-β2 levels over days 1–9 after hemorrhage than those who did not develop CCH.
The authors conclude that elevated TGF-β levels in the CSF after subarachnoid hemor-rhage are potential predictors of CCH and may indicate a need for early therapeutic inter vention.Original article Douglas MR et al. (2008) High CSF TGFβ levels after subarachnoid haemorrhage: association with chronic communicating hydrocephalus. J Neurol Neurosurg Psychiatry [doi:10.1136/jnnp.2008.155671]
Methylphenidate improves cognitive function during rehabilitation after TBI
Methylphenidate, a neural stimulant often used to treat attention-deficit hyperactivity disorder, can help to improve attention in patients who are undergoing rehabilitation after traumatic brain injury (TBI), a new study suggests.
Willmott and Ponsford assessed the efficacy of methylphenidate in improving different fea-tures of attention (sustained attention, working memory, strategic control, and speed of pro-cessing) in 40 patients with moderate to severe TBI (mean time since injury 68 days). Following an initial assessment, patients were randomly assigned to receive 3 days of methyl phenidate at a dose of 0.3 mg/kg (benchmark dose) and 3 days of placebo over a 2-week inpatient rehabilitation period. Attention was measured during each therapy session by a battery of tests, and a behavioral rating scale.
Compared with placebo administration, treatment with methylphenidate was associ-ated with a significant improvement in speed of information processing. The greatest response to the study drug was observed in the patients with the greatest injury severity and slowest baseline processing speed. Patients’ perfor-mance in the domains of working memory and strategic control did not show notable improvement when methylphenidate was received rather than placebo.
The authors propose further trials to assess the benefits of methylphenidate treatment over an extended duration as an adjunct to rehabilita tion therapy for patients with TBI.
Original article Willmott C and Ponsford J (2008) Efficacy of methylphenidate in the rehabilitation of attention following traumatic brain injury: a randomized, crossover, double-blind, placebo controlled inpatient trial. J Neurol Neurosurg Psychiatry [doi:10.1136/jnnp.2008.159632]
RESEARCH HIGHLIGHTS
ncpneuro_Mar09_HIGHLIGHTS.indd 125ncpneuro_Mar09_HIGHLIGHTS.indd 125 17/2/09 12:04:28 pm17/2/09 12:04:28 pm
© 2009 Macmillan Publishers Limited. All rights reserved
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