Johansson B, Wentzel A-P, Andréll P, Odenstedt J, Mannheimer C, Rönnbäck L
Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Gothenburg University , Gothenberg , Sweden .
Brain Inj. 2014;28(3):304-10. doi: 10.3109/02699052.2013.865267. Epub 2013 Dec 30.
The neurobehavioural symptoms and pain following traumatic brain injury (TBI) can be long-lasting. The condition impairs the persons' ability to function in their work, studies and gatherings with family and friends. The aim of this study was to investigate dosage, safety and effects of methylphenidate on mental fatigue and pain.
Twenty-nine physically-well rehabilitated TBI victims, 28 with a mild TBI and one with TBI and also with pain in the neck, shoulders and head were included in the study. Methylphenidate was tested in each patient using three treatment strategies: no medication, low dose (5 mg × 3) and normal dose (20 mg × 3) for 4 weeks using a randomized cross-over design.
Twenty-four patients completed the three treatment periods. Five participants discontinued, four females due to adverse reactions and one male due to attenuated motivation. Only minor adverse events were reported. Methylphenidate significantly decreased mental fatigue, as evaluated by the Mental Fatigue Scale (p < 0.001), and the effects on mental fatigue were dose-dependent. No effect on pain was detected.
Methylphenidate decreased mental fatigue for subjects suffering a traumatic brain injury, the treatment is considered to be safe and is recommended, starting with a low dose.
创伤性脑损伤（TBI）后的神经行为症状和疼痛可能会长期存在。这种情况会损害患者在工作、学习以及与家人和朋友聚会中的功能。本研究的目的是调查哌醋甲酯对精神疲劳和疼痛的剂量、安全性及效果。
29名身体康复的TBI受害者被纳入研究，其中28名患有轻度TBI，1名患有TBI且伴有颈部、肩部和头部疼痛。采用随机交叉设计，对每位患者使用三种治疗策略测试哌醋甲酯：不使用药物、低剂量（5毫克×3次）和正常剂量（20毫克×3次），为期4周。
24名患者完成了三个治疗阶段。5名参与者退出，4名女性因不良反应退出，1名男性因动机减弱退出。仅报告了轻微的不良事件。通过精神疲劳量表评估，哌醋甲酯显著降低了精神疲劳（p < 0.001），且对精神疲劳的影响呈剂量依赖性。未检测到对疼痛的影响。
哌醋甲酯可减轻创伤性脑损伤患者的精神疲劳，该治疗被认为是安全的，建议从低剂量开始使用。
