Neuropsychiatric Sequelae of Stroke and Traumatic Brain Injury: The Role of Psychostimulants

Abstract

Objective:

The primary purpose of this article is to review certain neuropsychiatric sequelae of stroke and traumatic brain injury (TBI), and the role of the psychostimulants methylphenidate (MPD) and dextroamphetamine (DAMP) in their treatment.

Method:

A general review of the topic is presented. Controlled and uncontrolled studies involving the use of the psychostimulants are discussed. These consist of 11 studies listed with Medline 2000 that deal specifically with stroke or head injury, with the oldest study reviewed dating back to 1984. Studies concerning the use of psychostimulants in the medically or neurologically ill are reviewed to the extent that they are pertinent.

Results:

The current literature consists primarily of uncontrolled case studies. However, these are reviewed and found to suggest a role for the use of the psychostimulants, which is discussed.

Conclusions:

In general, these drugs appear to be a reasonable treatment choice for certain types of mood, behavior, and cognitive symptoms following brain injury. However, it is noted that larger scale controlled studies are needed to adequately assess the clinical usefulness of these drugs.

Keywords

traumatic brain injury stroke methylphenidate dextroamphetamine psychostimulants neuropsychiatric sequelae cognition mood cortical recovery

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References

Randrup

and Munkvad

, Biochemical, Anatomical and Physiological Investigation of Stereotyped Behavior Induced by Amphetamines, in Amphetamines and Related Compounds, Costa

and Garratini

(eds.), Raven Press, New York, pp. 695–713, 1970.

Kuczenski

, Biochemical Actions of Amphetamines and Other Stimulants, in Stimulants: Neurochemical, Behavioral, and Clinical Perspectives, Creese

(ed.), Raven Press, New York, pp. 31–53, 1983.

Chieuh

C. C.

and Moore

K. E.

Blockage by Reserpine of Methylphenidate Induced Release of Brain Dopamine, Journal of Pharmacology and Experimental Therapeutics, 193: 559–563, 1975.

Gualtieri

C. T.

and Hicks

R. E.

The Neuropharmacology of Methylphenidate and a Neural Substrate of Childhood Hyperactivity, Psychiatric Clinics North America, 8: 875–892, 1985.

Altman

H. J.

and Quartermain

Facilitation of Memory Retrieval by Centrally Administered Catecholamine Releasing Agents, Behavioural Brain Research, 7: 51–63, 1983.

Robinson

R. G.

and Price

Post-stroke Depressive Disorders: A Follow-up Study of 103 Patients, Stroke, 113: 635–640, 1982.

Parikh

R. M.

Lipsey

J. R.

Robinson

A. G.

, and Price

Two Year Longitudinal Study of Post Stroke Mood Disorders: Dynamic Changes in Correlates of Depression at One and Two Years, Stroke, 13: 579–584, 1987.

Wade

D. T.

Legh-Smith

, and Hewer

R. A.

Depressed Mood after Stroke: A Community Study of its Frequency, British Journal of Psychiatry, 151: 200–205, 1987.

Astrom

Adolfson

, and Asplund

Major Depression in Stroke Patients; A 3-year Longitudinal Study, Stroke, 24: 976–982, 1993.

10.

House

Depression after Stroke, British Medical Journal, 294: 76–78, 1987.

11.

Robinson

R. G.

Bolla-Wilson

Kaplan

Lipsey

J. R.

, and Price

Depression Influences Intellectual Impairment in Stroke Patients, British Journal of Psychiatry, 148: 541–541, 1986.

12.

Sinyor

Amato

Kaloupek

Becker

Goldenberg

, and Coopersmith

Post-stroke Depression: Relationships to Functional Impairment, Coping Strategies, and Rehabilitation Outcome, Stroke, 17: 1102–1107, 1986.

13.

Morris

Robinson

Andrzejewski

Samuels

, and Price

Association of Depression with 10-year Poststroke Mortality, American Journal of Psychiatry, 150: 124–129, 1993.

14.

Angelieri

Foschi

Giaquinto

, and Nolfe

The Influence of Depression, Social Activity and Family Stress on Functional Outcome after Stroke, Stroke, 24: 1478–1483, 1993.

15.

Finkelstein

Campbell

Stoll

Baldessarini

Changes in Cortical and Subcortical Levels of Monoamines and their Metabolites Following Unilateral Ventrolateral Cortical Lesions in the Rat, Brain Research, 271: 279–288, 1983.

16.

Pearlson

G. D.

and Robinson

R. G.

Suction Lesions of the Frontal Cerebral Cortex in Rats Induce Asymmetrical Behavioral and Catechoaminergic Responses, Brain Research, 218: 233–244, 1981.

17.

Woodruff

M. L.

Baisden

R. H.

, and Fish

B. S.

Forebrain Catecholamine Concentrations in the Rat after Neocortical and Hippocampal Lesions, Life Sciences, 29: 2603–2607, 1981.

18.

Robins

R. G.

Kubos

K. L.

Starr

L. B.

Roa

, and Price

T. R.

Mood Disorders in Stroke Patients: Importance of Location of Lesion, Brain, 107: 81–93, 1984.

19.

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (3rd Edition, revised), APA, Washington, D.C., 1987.

20.

Lipsey

Robinson

Pearlson

Rao

, and Price

Nortriptyline Treatment of Post-stroke Depression: A Double Blind Study, Lancet, 1: 297–300, 1984.

21.

Reding

Orto

Winter

Fortuna

DiPonte

, and McDowell

Antidepressant Therapy after Stroke: A Double Blind Trial, Archives of Neurology, 43: 763–765, 1986.

22.

Murray

G. B.

Shea

, and Conn

Electroconvulsive Therapy for Poststroke Depression, Journal of Clinical Psychiatry, 47: 258–260, 1986.

23.

Kraus

M. F.

and Burch

E. A.

Methylphenidate Hydrochloride as an Antidepressant: Controversy, Case Studies and Review, Southern Medical Journal, 85: 985–991, 1992.

24.

Darvill

F. T.

and Wooley

Double Blind Evaluation of Methylphenidate Hydrochloride, Journal of the American Medical Association, 169: 1739–1741, 1959.

25.

Kaplitz

S. E.

Withdrawn, Apathetic Geriatric Patients Responsive to Methylphenidate, Journal of the American Geriatrics Society, 23: 271–276, 1975.

26.

Ferguson

J. T.

and Funderbuck

W. H.

Improving Senile Behavior with Reserpine and Ritalin, Journal of the American Medical Association, 160: 259–264, 1956.

27.

Natenshon

A. L.

Clinical Evaluation of Ritalin, Diseases of the Nervous System, 17: 392–396, 1956.

28.

Katon

and Raskind

Treatment of Depression in the Medically Ill Elderly with Methylphenidate, American Journal of Psychiatry, 137: 963–965, 1980.

29.

Kaufman

M. W.

Murray

G. B.

, and Cassem

N. H.

Use of Psychostimulants in Medically Ill Depressed Patients, Psychosomatics, 23: 817–819, 1982.

30.

Kaufman

M. W.

Cassem

N. H.

Murray

G. B.

Use of Psychostimulants in Medically Ill Patients with Neurological Disease and Major Depression, Canadian Journal of Psychiatry, 29: 46–49, 1984.

31.

Fisch

R. Z.

Methylphenidate for Medical Inpatients, International Journal of Psychiatry in Medicine, 15: 75–78, 1985.

32.

Kaufman

M. W.

Cassem

N. H.

Murray

G. B.

The Use of Methylphenidate in Depressed Patients after Cardiac Surgery, Journal of Clinical Psychiatry, 45: 82–84, 1984.

33.

Woods

S. W.

Tesar

G. E.

Murray

G. B.

Psychostimulant Treatment of Depressive Disorders Secondary to Medical Illness, Journal of Clinical Psychiatry, 47: 12–15, 1986.

34.

Fernandez

Levy

J. K.

Holmes

V. F.

Methylphenidate for Depressive Disorders in Cancer Patients, Psychosomatics, 28: 455–461, 1987.

35.

Pickett

Masand

, and Murray

G. B.

Psychostimulant Treatment of Geriatric Depressive Disorders Secondary to Medical Illness, Journal of Geriatric Psychiatry Neurology, 3: 146–151, 1990.

36.

Masand

Pickett

, and Murray

G. B.

Psychostimulants for Secondary Depression in Medical Illness, Psychosomatics, 32: 203–208, 1991.

37.

Lingam

V. R.

Lazarus

L. W.

Groves

Methylphenidate in Treating Post Stroke Depression, Journal of Clinical Psychiatry, 49: 151–153, 1988.

38.

Lazarus

Winemiller

Lingam

Neyman

Hartman

Abassian

Kartan

Groves

, and Fawcett

Efficacy and Side Effects of Methylphenidate for Poststroke Depression, Journal of Clinical Psychiatry, 53: 447–449, 1992.

39.

Wroblewski

McColgan

Smith

Whyte

, and Singer

The Incidence of Seizures During Tricyclic Antidepressant Drug Treatment in a Brain Injured Population, Journal of Clinical Psychopharmacology, 10: 1214–128, 1990.

40.

Wroblewski

Leary

Phelan

Whyte

, and Manning

Methylphenidate and Seizure Frequency in Brain Injured Patients, Journal of Clinical Psychiatry, 53: 86–89, 1992.

41.

Lemberger

Bergstrom

R. F.

Wolen

R. L.

Fluoxetine: Clinical Pharmacology and Physiologic Disposition, Journal of Clinical Psychiatry, 46: 14–19, 1985.

42.

Cole

J. O.

New Directions in Antidepressant Therapy: A Review of Sertraline, A Unique Serotonin Reuptake Inhibitor, Journal of Clinical Psychiatry, 53: 333–340, 1992.

43.

Crisostomo

E. A.

Duncan

P. W.

Propst

M. A.

Dawson

D. B.

, and Davis

J. N.

Evidence that Amphetamine with Physical Therapy Promotes Recovery of Motor Function in Stroke Patients, Annals of Neurology, 23: 94–97, 1988.

44.

Clark

A. N.

and Mankikar

M. B.

D-Amphetamine in Elderly Patients Refractory to Rehabilitation Procedures, Journal of American Geriatric Society, 27: 174–177, 1979.

45.

Frankowski

R. F.

Descriptive Epidemiologic Studies of Head Injury in the United States 1974–1984, Advances in Psychosomatic Medicine, 16: 153–172, 1986.

46.

Annegers

J. F.

Grabow

J. D.

Kurland

L. T.

The Incidences, Causes and Secular Trends of Head Trauma in Olmstead County, Minnesota, 1935–1974, Neurology, 30: 912–919, 1980.

47.

Kraus

J. F.

Black

M. A.

Hessol

The Incidence of Acute Brain Injury and Serious Impairment in a Defined Population, American Journal of Epidemiology, 119: 186–201, 1984.

48.

Whitman

Coonley-Hoganson

, and Desai

B. T.

Comparative Head Trauma Experiences in Two Socioeconomically Different Chicago Area Communities: A Population Study, American Journal of Epidemiology, 119: 570–580, 1984.

49.

Jane

J. A.

Rimel

R. W.

Pobereskin

L. H.

Tyson

G. W.

Stewart

, and Genarelli

T. A.

, Head Injury: Basic and Clinical Aspects, in Outcome and Pathology of Head Injury, Grossman

R. C.

and Gildenburg

P. L.

(eds.), Raven Press, New York, pp. 229–237, 1982.

50.

Gennarelli

T. A.

, Cerebral Concussions and Diffuse Brain Injuries, in Head Injury, Edition 2, Cooper

P. R.

(ed.), Williams and Wilkins, Baltimore, pp. 108–124, 1987.

51.

Auerbach

S. H.

, The Pathophysiology of Traumatic Brain Injury, in Physical Medicine and Rehabilitation—State of the Art Reviews: Traumatic Brain Injury, Horn

L. J.

and Cope

D. N.

(eds.), Hanley and Belfus, Philadelphia, pp. 1–11, 1989.

52.

Gualtieri

T. C.

, Pharmacotherapy and the Neurobehavioral Sequelae of Traumatic Brain Injury, Brain Injury, 2: 101–129, 1988.

53.

Gualtieri

C. T.

and Evans

R. W.

Stimulant Treatment for the Neurobehavioral Sequelae of Traumatic Brain Injury, Brain Injury, 2: 273–290, 1988.

54.

Rimel

R. W.

Giordani

Barth

J. T.

Boll

T. J.

, and Jane

Disability Caused by Minor Head Injury, Neurosurgery, 9: 221–228, 1981.

55.

Levin

H. S.

Mattis

Ruff

R. M.

Eisenberg

H. M.

Marshall

L. F.

Tabaddor

High

W. M.

, and Frankowski

Neurobehavioral Outcome Following Minor Head Injury: A Three Center Study, Journal of Neurosurgery, 66: 234–243, 1987.

56.

Evans

R. W.

The Postconcussion Syndrome and the Sequelae of Mild Head Injury, Neurologic Clinics, 10: 815–847, 1992.

57.

Alves

Colohan

O'Leary

Rimel

R. W.

, and Jane

Understanding Post-traumatic Symptoms after Minor Head Injury, Journal of Head Trauma Rehabilitation, 1: 1–12, 1986.

58.

Fedoroff

Starkstein

Forrester

Geisler

Jorge

Arndt

, and Robinson

Depression in Patients with Acute Traumatic Brain Injury, American Journal of Psychiatry, 149: 918–923, 1992.

59.

Jorge

Robinson

R. G.

Arndt

Forrester

Geisler

, and Starkstein

Comparison Between Acute- and Delayed-onset Depression Following Traumatic Brain Injury, Journal of Neuropsychiatry, 5: 43–49, 1993.

60.

Parmelee

D. X.

and O'Shanick

G. J.

Neuropsychiatric Interventions with Head Injured Children and Adolescents, Brain Injury, 1: 41–47, 1987.

61.

Evans

R. W.

Gualtieri

C. T.

, and Patterson

D. R.

Treatment of Chronic Closed Head Injury with Psychostimulant Drugs: A Controlled Case Study an Appropriate Evaluation Procedure, Journal of Nervous Mental Disorders, 175: 106–110, 1987.

62.

Lipper

and Tuchman

Treatment of Chronic Post-traumatic Organic Brain Syndrome with Dextroamphetamine: First Reported Case, Journal of Nervous Mental Disorders, 162: 366–371, 1976.

63.

Orlosky

M. J.

The Klein-Levin Syndrome: A Review, Psychosomatics, 23: 609–621, 1982.

64.

Evans

R. W.

Gualtieri

C. T.

, and Amara

Methylphenidate and Memory: Dissociated Effects in Hyperactive children, Psychopharmacology, 90: 211–216, 1986.

65.

Speech

T. J.

Rao

S. M.

Osmon

D. C.

, and Sperry

L. T.

A Double Blind Controlled Study of Methylphenidate in Closed Head Injury, Brain Injury, 7: 333–338, 1993.

66.

Bleiberg

Garmoe

Cedarquist

Reeves

, and Lux

Effects of Dexedrine on Performance Consistency Following Brain Injury, Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 6: 245–248, 1993.

67.

Feeney

D. M.

and Sutton

R. L.

Pharmacotherapy for Recovery of Function after Brain Injury, CRC Critical Review in Neurobiology, 3: 135–197, 1993.

68.

Feeney

Gonzales

, and Law

Amphetamine, Haloperidol, and Experience Interact to Affect Rate of Recovery after Motor Cortex Injury, Science, 217: 855–857, 1982.

69.

Dietrich

W. D.

Alonso

Busto

Watson

B. D.

Loor

, and Ginsberg

M. D.

Influence of Amphetamine Treatment on Somatosensory Function of the Normal and Infarcted Rat Brain, Stroke, 21(suppl III): 147–150, 1990.

70.

Gold

P. E.

Delanoy

R. L.

, and Merrin

Modulation of Long-term Potentiation by Peripherally Administered Amphetamine and Epinephrine, Brain Research, 305: 103–107, 1984.

71.

Hovda

D. A.

and Feeney

D. M.

Amphetamine with Experience Promotes Recovery of Locomotor Function after Unilateral Frontal Cortex Injury in the Cat, Brain Research, 298: 358–361, 1984.

72.

Sutton

R. L.

Hovda

D. A.

, and Feeney

D. M.

Amphetamine Accelerates Recovery of Locomotor Function following Bilateral Frontal Cortex Ablation in Cats, Behavioral Neuroscience, 103: 837–841, 1989.

73.

Goldstein

L. B.

, Amphetamine Facilitated Functional Recovery after Stroke, in Cerebrovascular Diseases, Sixteenth Research Conference, Ginsburg

M. D.

and Dietrich

W. D.

(eds.), Raven Press, New York, pp. 303–308, 1988.

74.

Goldstein

L. B.

Pharmacology of Recovery after Stroke, Stroke, 21: 132–139, 1990.

75.

Little

K. Y.

D-amphetamine versus Methylphenidate Effects in Depressed Patients, Journal of Clinical Psychiatry, 54: 349–355, 1993.