Neurostimulant use to facilitate recovery after traumatic brain injury in an adolescent patient with preexisting ADHD: a case report.

BACKGROUND: Neurostimulants are commonly used after traumatic brain injury (TBI) to improve arousal, attention, and participation in rehabilitation. However, little is known about stimulant use among pediatric patients with preexisting attention-deficit/hyperactivity disorder (ADHD). We describe stimulant use to facilitate emergence from post-traumatic amnesia (PTA) in an adolescent with severe TBI and preexisting ADHD. CASE PRESENTATION: A 14-year-old male with ADHD sustained a severe TBI with diffuse axonal injury following an electric scooter crash. He experienced prolonged PTA, severe agitation, and motor restlessness despite multimodal pharmacologic management and environmental interventions. On post-injury day 17, a trial of methylphenidate produced rapid improvements in attention and agitation. Agitated Behavior Scale scores subsequently decreased, and he emerged from PTA by post-injury day 23. DISCUSSION: This case highlights a potential role for individualized neurostimulant therapy in facilitating recovery after severe TBI among adolescents with preexisting ADHD. To our knowledge, this is the first pediatric case in the literature describing stimulant use to facilitate emergence from PTA in a patient with preexisting ADHD. Further research is needed to establish evidence-based guidance for stimulant selection, dosing, and timing of re-initiation after pediatric TBI.