Rees Jemima L C, Saunders Rachel, Krynicki Carl R, Belli Antonio, Ahmed Zubair, Di Pietro Valentina, Stevens Andrew R
Neuroscience and Ophthalmology, Department of Inflammation and Ageing, School of Infection, Inflammation and Immunology, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom.
School of Psychology, University of Birmingham, Birmingham, United Kingdom.
Front Neurol. 2025 Mar 5;16:1546080. doi: 10.3389/fneur.2025.1546080. eCollection 2025.
Traumatic brain injury (TBI) is a leading cause of death and disability globally and is associated with long-term cognitive and neurobehavioural deficits. Methylphenidate has been proposed to address these lasting symptoms, however comprehensive evidence is lacking.
This systematic review aimed to assess the effects of methylphenidate on multiple cognitive and neurobehavioural domains in adults with TBI. The search conducted across five databases yielded 1,019 results, of which 25 were relevant to this review. Meta-analyses were conducted where homogenous data was available.
Significant results favouring methylphenidate were recorded by meta-analyses for one of five cognition outcome measures (Trail Making Test A) ( = 0.005, CI [-5.19, -0.91]), as well as the depression domain ( < 0.00001, CI [-0.78, -0.39]) and the fatigue domain ( < 0.00001, CI [-0.98, -0.67]). Insufficient data was available in the aggression, apathy, agitation, memory, motor function, post-concussion syndrome and sleep domains for inclusion in meta-analysis. Qualitative review of evidence in these domains found limited and mixed evidence on the efficacy of methylphenidate, though significant benefits have been demonstrated in these various domains in small, randomised studies. Eleven of the 25 studies were judged as containing some to high risk of bias. However, this review identified supportive evidence for the beneficial effects of methylphenidate to improve depression and fatigue in adults with TBI, with some possible benefits for cognition and other symptoms. Heterogeneity was high and risk of bias was variable across studies, somewhat limiting credibility of results.
Methylphenidate may enhance the ongoing care of TBI patients, by addressing neurobehavioural and cognitive symptoms simultaneously. Further large-scale and high-quality clinical trials evaluating a comprehensive range of possible benefits to symptoms should be conducted to more conclusively elucidate the potential of methylphenidate for clinical efficacy in TBI.
创伤性脑损伤（TBI）是全球范围内导致死亡和残疾的主要原因，并且与长期的认知和神经行为缺陷相关。已有人提出使用哌醋甲酯来解决这些持续症状，然而缺乏全面的证据。
本系统评价旨在评估哌醋甲酯对成年TBI患者多个认知和神经行为领域的影响。在五个数据库中进行的检索产生了1019条结果，其中25条与本评价相关。在可获得同质数据的情况下进行了荟萃分析。
荟萃分析记录了在五项认知结果测量中的一项（连线测验A）（P = 0.005，CI [-5.19，-0.91]）以及抑郁领域（P < 0.00001，CI [-0.78，-0.39]）和疲劳领域（P < 0.00001，CI [-0.98，-0.67]）中，支持哌醋甲酯的显著结果。在攻击、冷漠、激越、记忆、运动功能、脑震荡后综合征和睡眠领域，没有足够的数据纳入荟萃分析。对这些领域证据的定性评价发现，关于哌醋甲酯疗效的证据有限且参差不齐，尽管在小型随机研究中已证明在这些不同领域有显著益处。25项研究中有11项被判定存在一些至高度偏倚风险。然而，本评价确定了支持哌醋甲酯对改善成年TBI患者抑郁和疲劳有益效果的证据，对认知和其他症状可能也有一些益处。异质性较高，且各研究的偏倚风险各不相同，这在一定程度上限制了结果的可信度。
哌醋甲酯可通过同时解决神经行为和认知症状来加强对TBI患者的持续护理。应进行进一步的大规模、高质量临床试验，评估对症状的一系列可能益处，以便更确凿地阐明哌醋甲酯在TBI临床疗效方面的潜力。
