title: Aggregated n-of-1 trials of central nervous system stimulants versus placebo for paediatric traumatic brain injury--a pilot study.
abstract: BACKGROUND
  In 2006 there were 432,700 people in Australia who had acquired brain injury (ABI) with some limitation of activities; 90% of these were traumatic brain injuries (TBIs) and nearly a third sustained injury below age 15 years. One to four years post injury, 20% to 46% of children with traumatic brain injury (TBI) have clinically significant disorders of attention. There is controversy as to whether central nervous system (CNS) stimulants can be an effective method of treating these.Objectives were to determine the efficacy of CNS stimulants for children with TBI, and to calculate the sample size for a larger trial using the Conners' 3 Parent Rating Scales Score as the primary endpoint.
  
  
  METHODS
  Pilot series of aggregated prospective randomised, double-blind, n-of-1 trials of stimulant versus placebo within individual patients.
  
  
  METHODS
  tertiary children's public hospital.
  
  
  METHODS
  ten children aged 6 to 16 years more than 12 months post TBI with attention, concentration and behavioral difficulties on stimulants.
  
  
  METHODS
  Three cycles of methylphenidate or dexamphetamine orally at doses titrated by physician compared to placebo.
  
  
  METHODS
  Conners 3 Parent (Conners 3-P) and Teacher (Conners 3-T) Rating Scales (Global Index), Behaviour Rating Inventory of Executive Function (BRIEF) and Eyberg Child Behaviour Inventory (ECBI).
  
  
  RESULTS
  Five of ten patients completed the study. Data from 18 completed cycles from seven patients were analysed. The posterior mean difference between stimulant and placebo scores for the Conners 3-PS (Global Index) was 2.3 (SD 6.2; 95% credible region -1.0 to 6.1; posterior probability that this mean difference was greater than zero was 0.92), and for the Conners 3-T (Global Index) the posterior mean difference was 5.9 (SD 4.5; 95% credible region -3.1 to 14.9; posterior probability 0.93). Posterior mean differences suggest improvement in behaviour and executive function and a decrease in number and intensity of child behaviour problems when taking stimulants compared to placebo. Taken together these data are suggestive of a small benefit at group level.
  
  
  CONCLUSIONS
  In this pilot study, there was sufficient evidence that stimulants may be useful in management of behavioral and cognitive sequelae following TBI, to warrant a larger trial.
  
  
  BACKGROUND
  he trial was registered with the Australian and New Zealand Clinical Trials Registry: registration number ACTRN12609000873224.
authors: School of Medicine, The University of Queensland, Ipswich campus, Building 12, Salisbury Rd, Ipswich 4305, Australia. uqjnikle@uq.edu.au.
authors: Catherine J
authors: CJ
authors: Nikles
authors: Lynne
authors: L
authors: McKinlay
authors: Geoffrey K
authors: GK
authors: Mitchell
authors: Sue-Ann S
authors: SA
authors: Carmont
authors: Hugh E
authors: HE
authors: Senior
authors: Mary-Clare A
authors: MC
authors: Waugh
authors: Adrienne
authors: A
authors: Epps
authors: Philip J
authors: PJ
authors: Schluter
authors: Owen T
authors: OT
authors: Lloyd
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000187:drug effects*; D000367:Age Factors; D001288:Attention / Q000187:drug effects; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D001921:Brain / Q000187:drug effects* / Q000503:physiopathology; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002652:Child Behavior / Q000187:drug effects*; D002675:Child, Preschool; D018592:Cross-Over Studies; D003913:Dextroamphetamine / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D056344:Executive Function / Q000187:drug effects; D005260:Female; D006776:Hospitals, Pediatric; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage* / Q000009:adverse effects; D010865:Pilot Projects; D011446:Prospective Studies; D011793:Queensland; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D003913:Dextroamphetamine