PubMed · 14345199
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G Lindqvist. 1964. MENTAL CHANGES AFTER HYPOPHYSECTOMY.. https://doi.org/10.1111/j.1600-0447.1964.tb04914.x
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BACKGROUND: A significant number of studies have shown that critically ill patients with brain injury (BI) frequently exhibit abnormal pituitary hormonal responses during the immediate postinjury period. DISCUSSION: The elucidation of endocrine alterations depends on the criteria used, the diagnostic tests applied, and the timing of testing in relation to BI. The pattern of the detected hormonal abnormalities shows considerable variability. Altered endocrine responses are due mostly to hypothalamic changes rather than to pituitary dysfunction. Several studies have examined the correlation between hormonal alterations and BI severity, but the results are inconsistent. Furthermore, it remains currently unclear whether and how pituitary abnormalities adversely affect the clinical course of BI patients during the period of critical illness. On the basis of current knowledge, with the exception of clinically significant relative adrenal deficiency and diabetes insipidus, the other endocrine alterations do not seem to require any therapeutic intervention in severely ill BI patients. It is also uncertain whether hormonal abnormalities detected in the early post-BI period persist for the rest of these patients' lives. CONCLUSIONS: In view of current evidence indicating a high incidence of pituitary dysfunction even years following BI it is recommended that repetition of endocrine evaluation should be performed during the rehabilitation phase in all patients.
OBJECTIVE: To review literature regarding the effectiveness of methylphenidate in the management of the cognitive and behavioral changes observed following traumatic brain injury (TBI). DATA SOURCES: A literature search was conducted using the following databases: MEDLINE (1966-June 2004); Cochrane Central Register of Controlled Trials, fourth quarter 2004 (1988-June 2004); and International Pharmaceutical Abstracts (1970-June 2004). Methylphenidate and brain injury were the key search terms used. Limits were set to include clinical trial publications, human subjects, and English language. DATA SYNTHESIS: Ten clinical trials evaluating the efficacy and safety of methylphenidate in pediatric and adult patients with TBI are reviewed. Improvements in different aspects of cognition and behavior were evaluated before, during, and after treatment with methylphenidate. The results demonstrated that methylphenidate is likely to improve memory, attention, concentration, and mental processing, but its effects on behavior have not been determined. CONCLUSIONS: Larger, double-blind, placebo-controlled studies are needed to determine optimal doses, during which phase of recovery to begin treatment, length of treatment, and long-term effects for patients with mild, moderate, and severe TBI.
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