Treatment of Traumatic Brain Injury (TBI)-Related Attention Deficits

Symptoms of inattentiveness, impulsivity, and poor persistence have been observed in both
children and adults following traumatic brain injury (TBI). These often are among the most
prominent symptoms manifested and may contribute to interference in a variety of other
functional domains. Although there has been some use of psychostimulant medication to treat
TBI-acquired attention deficits, it remains a relatively uncommon clinical practice. This
study, by highlighting mechanisms of action, could serve to promote the appropriate use of
this type of treatment for the patients.

Inclusion Criteria:

- Males and females, ages 16 to 45

- Closed head injury rated as moderate/severe (based on Glasgow Coma Scale rating,
estimated posttraumatic amnesia, etc.)

- Sustained 6 to 36 months earlier, and considered to be neurologically stable

- Persistent (> 6 months) problems with focused or sustained attention (+1 SD or worse
on Inattention component of ADHD self ratings) corroborated by professional staff
(nurses, therapists, etc.) or caregivers. Problems with attention/concentration rated
as among most prominent cognitive changes.

- Accompanying features may include diminished arousal/speed/stamina and/or
disinhibited symptoms

Exclusion Criteria:

- Penetrating head injury

- Pre-injury history of diagnosed ADHD

- Other psychiatric conditions such as mania or psychosis. Current posttraumatic stress
disorder (PTSD) symptoms may be present but not so severe as to require pharmacologic
treatment.

- Lifetime history of psychostimulant abuse or dependence. Other (non-psychostimulant)
substance abuse within the past 6 months. Total lifetime drug use will not exceed 5
times each for substances such as amphetamine, meth-amphetamine, or cocaine.

- Prior treatment with psychostimulant(s)

- Tics or other contraindications for psychostimulant use including arteriosclerosis,
cardiovascular disease, uncontrolled hypertension or hyperthyroidism, glaucoma,
agitation, use of MAO inhibitor within 6 weeks

- Current treatment with other psychotropic medication(s) within the past 6 weeks

- Estimated IQ < 80

- Sensory and/or motor impairment(s) seriously limiting testing options

- Other neurological conditions including epilepsy, degenerative disorders, brain
tumor, or stroke.

- Physical conditions affecting arousal, activity level or stamina, including
uncontrolled thyroid dysfunction, anemia, autoimmune or metabolic disorders,
untreated moderate/severe sleep apnea, etc.

- Persons for whom MRI scanning is contraindicated, including weight greater than 275
pounds (due to scanner table limitations), severe claustrophobia, implanted
electronic medical devices (e.g. pacemaker, cochlear or other inner ear implant, deep
brain stimulator), metallic foreign object in eye or rest of the body, history of
sheet metal work, aneurysm clips, non-removable metallic piercings, and dental
prosthetics.