Immediate neurocognitive effects of methylphenidate on learning-impaired survivors of childhood cancer

Purpose: To test if methylphenidate (MPH) has an objective beneficial effec t on immediate performance on tests of neurocognitive functions among learn ing-impaired survivors of childhood acute lymphoblastic leukemia (ALL) and malignant brain tumors (BT). Patients and Methods: From July 1, 1997 through December 31, 1998, 104 long -term survivors of childhood ALL or a malignant BT completed neurocognitive screening for learning impairments and concurrent problems with sustained attention. Eligibility criteria for the MPH trial included an estimated int elligence quotient greater than 50, academic achievement in the 16(th) perc entile or lower for age in reading, math, or spelling, and an ability to su stain attention on a computerized version of the Conners' Continuous Perfor mance Test (CPT) in the 16(th) percentile or lower for age and sex. Of the 104, 32 (BT, n = 25; ALL, n = 7) were eligible on the basis of these a prio ri criteria for a randomized, double-blinded, placebo-controlled trial of M PH. The patients ingested a placebo (lactase) or MPH (0.6 mg/ kg; 20 mg max imum) and repeated selected portions of the screening battery 90 minutes la ter. Results: Compared to the 17 patients randomized to the placebo group, the 1 5 patients randomized to the MPH group had a significantly greater improvem ent on the CPT for sustained attention (errors of omission, P = .015) and o verall index (P = .008) but not for errors of commission (indicative of imp ulsiveness) nor reaction times. A trend for greater improvement in the MPH group on a measure of verbal memory failed to reach statistical significanc e. No trend was observed far MPH effective ness in improving learning of a word association task. No significant side effects from MPH were observed. Conclusion: MPH resulted In a statistically significant improvement on meas ures of attention abilities that cannot be explained by placebo or practice effects. (C) 2001 by American Society of Clinical Oncology.