title: Caffeine as a neurostimulant: Two pediatric acquired brain injury cases.
abstract: OBJECTIVE
  This report describes two pediatric patients undergoing acute inpatient rehabilitation for acquired brain injury.
  
  
  METHODS
  The first patient was a 16-year-old African American female with an acquired brain injury from multiple intracranial hemorrhages secondary to an arteriovenous malformation. The second patient was a 16 year-old African American male who sustained a traumatic brain injury due to assault. In both cases, the patients had difficulty participating in therapy due to significant attention/arousal impairments.
  
  
  RESULTS
  Both patients demonstrated functional improvements after the initiation of caffeine 80 mg daily. The first patient's function improved from being unable to communicate to being able to signal yes/no with thumb movements. The functional independence measurement (FIM) scores of the second patient improved dramatically after caffeine was initiated. His function improved from being totally dependent in ambulation, wheelchair ambulation, and communication to only requiring moderate assistance with ambulation and supervision with wheelchair ambulation and communication after 3 weeks of treatment. The second patient's attention/arousal and FIM scores declined when caffeine was stopped for 3 days and improved once administration of caffeine resumed. There were no adverse events reported for either patient.
  
  
  CONCLUSIONS
  Caffeine is a safe and inexpensive neurostimulant that may be used to treat attention/arousal impairments. Additional research is warranted to determine criteria of use, optimal timing, duration, and dosing of caffeine administration and to investigate whether caffeine improves chronic functional outcomes after ABI in pediatric acquired brain injury patients.
authors.affiliation: Physical Medicine and Rehabilitation Service, Jesse Brown VA Medical Center, USA Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Barrett
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Casey
authors.forename: Charles
authors.initials: C
authors.lastname: Sisung
authors.forename: Deborah
authors.initials: D
authors.lastname: Gaebler-Spira