The use of dopamine enhancing medications with children in low response states following brain injury.
OBJECTIVE
The study examines the possible relationship between dopamine-enhancing medications and improvement of arousal and awareness in children during persistent low response states (Rancho Los Amigos Levels I, II and III).


METHODS
A retrospective review was conducted of 10 children enrolled in an existing clinical protocol. The Kluge Children's Rehabilitation Center (KCRC) low response protocol provides a double baseline serial measure (A, A, B, B, B) design. Scores on the Western NeuroSensory Stimulation Profile (WNSSP) are the dependent variable.


METHODS
Ten children, mean age of 13.7 years low response state (30 days or more) who were treated with dopamine agonists. Co-morbid or iatrogenic influences were addressed or ruled out. Seven children had traumatic brain injury, one cerebral vascular accident, one anoxia and one encephalitis.


METHODS
On average, dopamine medications were started 52.9 days post-event.


RESULTS
Paired t-test of WNSSP scores before medications and on medications were significant at p = 0.03 (paired t-test). Also, the distributions of the slopes (rates of change of WNSSP scores over time) were significantly different in the pre-medication and medication phases (Paired T-test, p = 0.02). Random coefficient model comparison of individuals during pre- and medication phase response variability on WNSSP yielded F-test at p = 0.02.


CONCLUSIONS
These results suggest a promising relationship between acceleration of recovery for some children in a low response state and administration of dopamine-enhancing medications.
Department of Pediatrics, Kluge Children's Rehabilitation Center and Research Institute, University of Virginia Children's Medical Center, Charlottesville, VA 22903, USA. pdp2n@virginia.edu
P D
PD
Patrick
M L
ML
Buck
M R
MR
Conaway
J A
JA
Blackman
D000293:Adolescent; D000328:Adult; D000547:Amantadine / Q000627:therapeutic use; D001143:Arousal / Q000187:drug effects*; D001364:Awareness / Q000187:drug effects*; D052160:Benzothiazoles; D001930:Brain Injuries / Q000188:drug therapy / Q000503:physiopathology*; D001971:Bromocriptine / Q000627:therapeutic use; D002648:Child; D015259:Dopamine Agents / Q000627:therapeutic use*; D018491:Dopamine Agonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D009483:Neuropsychological Tests; D000077487:Pramipexole; D012189:Retrospective Studies; D013844:Thiazoles / Q000627:therapeutic use; D016896:Treatment Outcome; D014474:Unconsciousness / Q000188:drug therapy / Q000503:physiopathology*
D052160:Benzothiazoles; D015259:Dopamine Agents; D018491:Dopamine Agonists; D013844:Thiazoles; D008774:Methylphenidate; D001971:Bromocriptine; D007980:Levodopa; D000077487:Pramipexole; D000547:Amantadine