Poster 10: Cognitive and Functional Improvement in a Pediatric Patient with Acute Disseminated Encephalomyelitis Following Methylphenidate Treatment: A Case Report

Article Outline

• Disclosures
• Patients or Programs
• Program Description
• Setting
• Results
• Discussion
• Conclusions
• Copyright

Keywords: Rehabilitation, Pediatrics, Acute disseminated encephalomyelitis, Methylphenidate

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Disclosures 

J. Colyer, None.

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Patients or Programs 

A 4-year-old girl with acute disseminated encephalomyelitis (ADEM).

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Program Description 

The patient was admitted to the brain injury unit of an acute rehabilitation hospital 10 days after diagnosis and treatment at a pediatric hospital. Residual effects from the disease process in this patient included flaccid limbs and generalized weakness with total dependence required for many activities of daily living (ADLs), cognitive slowing with decreased verbalization and play, and lethargy. After 1 week of inpatient rehabilitation, patient made no functional or cognitive gains. Plans were made to start patient on a neurostimulant. Patient was on daily dosing of amantadine for 1 day; however, this was not tolerated secondary to severe nausea and vomiting. Daily dosing of 2.5 mg oral methylphenidate (MPH) was initiated on rehab day 10. This dosage was titrated to 2.5 mg twice daily dosing (administered at 7am and noon) on rehab day 14.

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Setting 

Acute rehabilitation hospital.

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Results 

Prior to the administration of MPH, the patient remained lethargic and made poor functional gains during her acute inpatient rehabilitation stay. Within 24 hours of the initiation of MPH, the patient's condition markedly improved, including increased alertness and ability to communicate, increased age-appropriate play, and improved performance of ADLs.

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Discussion 

MPH is a mild central nervous system stimulant that is indicated by the FDA for use in the treatment of attention deficit disorder and narcolepsy. MPH has also been used off label for decades for the treatment of cognitive dysfunction in traumatic brain injury in both the adult and pediatric population. MPH aided in improving arousal and attention in this patient, which contributed to the efficacy of her therapy sessions.

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Conclusions 

MPH was used successfully as a neurostimulant in this pediatric patient with ADEM. Further investigation and controlled studies would be warranted in the future.