Clinical Neurology and Neurosurgery 108 (2006) 539–542
Effect of methylphenidate on ICU and hospital length of stay in
patients with severe and moderate traumatic brain injury
, Hossein A. Khalili
, Kamyar Keramatian
Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Neuroscience, University of British Columbia, Vancouver, Canada
Received 26 February 2005; received in revised form 28 August 2005; accepted 4 September 2005
Objective: Traumatic brain injury is one of the major causes of death and disability among young people. Methylphenidate, a neural stimulant
and protective drug, which has been mainly used for childhood attention deﬁcit/hyperactivity disorder, has shown some beneﬁts in late
psychosocial problems in patients with traumatic brain injury. Its effect on arousal and consciousness has been also revealed in the sub-acute
phase of traumatic brain injury. We studied its effect on the acute phase of moderate and severe traumatic brain injury (TBI) in relation to the
length of ICU and hospital admission.
Patients and methods: Severely and moderately TBI patients (according to inclusion and exclusion criteria) were randomized to treatment
and control groups. The treatment group received methylphenidate 0.3 mg/kg per dose PO BID by the second day of admission until the time
of discharge, and the control group received a placebo. Admission information and daily Glasgow Coma Scale (GCS) were recorded. Medical,
surgical, and discharge plans for patients were determined by the attending physician, blinded to the study.
Results: Forty patients with severe TBI (GCS = 5–8) and 40 moderately TBI patients (GCS = 9–12) were randomly divided into treatment
and control groups on the day of admission. In the severely TBI patients, both hospital and ICU length of stay, on average, were shorter in the
treatment group compared with the control group. In the moderately TBI patients while ICU stay was shorter in the treatment group, there
was no signiﬁcant reduction of the period of hospitalization.
Conclusion: There were no signiﬁcant differences between the treatment and control groups in terms of age, sex, post resuscitation GCS, or
brain CT scan ﬁndings, in either severely or moderately TBI patients.
Methylphenidate was associated with reductions in ICU and hospital length of stay by 23% in severely TBI patients (P = 0.06 for ICU and
P = 0.029 for hospital stay time). However, in the moderately TBI patients who received methylphenidate, there was 26% fall (P = 0.05) only
in ICU length of stay.
© 2005 Elsevier B.V. All rights reserved.
Keywords: Ritalin; Methylphenidate; Severe traumatic brain injury; Moderate traumatic brain injury
The prevalence and intensity of traumatic brain injury are
increasingly rising amongst Iranians. Most of the time, there
is a long waiting list of patients with traumatic brain injury
Corresponding author. Present address: Department of Neurosurgery,
Kashani Hospital, Isfahan, Iran. Tel.: +98 9173174156.
E-mail addresses: firstname.lastname@example.org (H.A. Khalili),
email@example.com (K. Keramatian).
Present address: Department of Neurosurgery, Alzahra Hospital,
for ICU admission, which imposes a heavy ﬁnancial burden
Methylphenidate (Ritalin), a central nervous system stim-
ulant with dopaminergic and slight noradrenergic activity, has
been known for a long time [1,2]. This drug has been approved
by the FDA for treatment of children’s attention deﬁcit hyper-
activity disorder, narcolepsy, and refractory depression [2,3].
Moreover, neuroprotective effects have been attributed to
Methylphenidate like aspartate inhibitors .
Several studies have shown that methylphenidate can
improve cognitive function and behavior in post traumatic
brain injured (TBI) adults [3–7] and children [8,9]; however,
0303-8467/$ – see front matter © 2005 Elsevier B.V. All rights reserved.