Hagan Alexander J, Hill Rebecca M, Kingston Andrew, Bailey Simon, Verity Sarah J
School of Medicine, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.
Department of Paediatric Health Psychology, Paediatric Neuro-Oncology, Great North Children's Hospital, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK.
J Neurooncol. 2025 Nov;175(2):801-812. doi: 10.1007/s11060-025-05177-9. Epub 2025 Jul 31.
Survivors of childhood brain tumour face significant neurocognitive late effects, including impairment in processing speed and attention. Deficits to these core cognitive domains contribute to the plateauing of age-appropriate intellectual development as the child matures. While short-term studies demonstrate the utility of methylphenidate in enhancing processing speed and attention during early recovery, its longer-term role in sustaining intellectual development remains underexplored.
The current study examined the long-term effects of methylphenidate on intellectual development in 23 survivors of childhood brain tumour, matched on multiple clinical and demographic variables against 23 controls. Intellectual assessments were conducted at baseline and after 12 months of treatment. Statistical analyses evaluated the degree of change in intellectual trajectories between groups over time.
Bayesian hierarchical modelling showed distinct intellectual trajectories between groups, with consistent declines in the control group. Treatment with methylphenidate was associated with the preservation of age-appropriate intellectual development, with the highest posterior probability of treatment-related benefit to Fluid Reasoning (0.97), and strong-to-moderate evidence of benefits to Verbal Comprehension (0.92), Working Memory (0.91), and Processing Speed (0.84). Frequentist analyses supported these findings, demonstrating significant preservation of Fluid Reasoning over time (t = 2.14, p = 0.04). The use of chemotherapy was associated with a significant decline in Fluid Reasoning across the entire dataset; this effect was only sustained in the control group (β = - 18.6, p = 0.03).
These findings highlight the long-term rehabilitative potential of methylphenidate and suggest its wider adoption could support care for survivors at risk of intellectual plateau.
儿童脑肿瘤幸存者面临显著的神经认知后期影响，包括处理速度和注意力受损。随着儿童成长，这些核心认知领域的缺陷导致与其年龄相符的智力发展停滞。虽然短期研究表明哌甲酯在早期康复过程中对提高处理速度和注意力有用，但其在维持智力发展方面的长期作用仍未得到充分探索。
本研究调查了哌甲酯对23名儿童脑肿瘤幸存者智力发展的长期影响，这些幸存者在多个临床和人口统计学变量上与23名对照者匹配。在基线和治疗12个月后进行智力评估。统计分析评估了两组之间智力轨迹随时间的变化程度。
贝叶斯分层模型显示两组之间存在不同的智力轨迹，对照组持续下降。哌甲酯治疗与维持与其年龄相符的智力发展相关，对流体推理的治疗相关益处的后验概率最高（0.97），对言语理解（0.92）、工作记忆（0.91）和处理速度（0.84）有强到中等程度的益处证据。频率学派分析支持了这些发现，表明流体推理随时间显著维持（t = 2.14，p = 0.04）。在整个数据集中，化疗的使用与流体推理的显著下降相关；这种影响仅在对照组中持续存在（β = -18.6，p = 0.03）。
这些发现突出了哌甲酯的长期康复潜力，并表明更广泛地采用它可以支持对有智力停滞风险的幸存者的护理。
