Height, weight, and cardiovascular effects of stimulants on children with brain tumors

Abstract

Introduction: Children with brain tumors may develop inattention, slow processing, and hypersomnia. Stimulant medications improve these problems, but their effect on growth, heart rate, and blood pressure (BP) are inadequately explored. Procedure: We retrospectively studied children with brain tumors treated at our institution that had data available for 1 year pre and 2 years on stimulant treatment. Tumor location, gender, radiation treatment (RT), age at RT, drug type, and hormone therapy were variables of interest. Results: We identified 65 children (35 males) that fulfilled eligibility criteria. Focal RT was utilized in 58; 11 additionally had whole brain RT; and seven received no RT. Thirty were treated for hypersomnia and inattention, eight for hypersomnia alone, and rest for inattention. Modafinil was the first drug in 18 (27.7%), and methylphenidate in the others. Forty-seven (72.3%), 45 (69.2%), and 49 (75.4%) were on thyroxine, cortisone, and growth hormones, respectively. There was no difference in pre-and post-stimulant body mass index (BMI), heart rate, and BP. There was also no difference between modafinil and methylphenidate groups. Rate of height acquisition slowed on stimulants (P = .0096). Thyroxine treatment correlated with increase in BMI after stimulants (P = .04). Younger age (P = .0003) and higher prestimulant BMI (P = .0063) correlated with increased heart rate on stimulants, while higher age at RT (P =.016) correlated with elevated systolic BP on stimulants. No associations were found with height acquisition and diastolic BP. Conclusion: Stimulants are well tolerated by children with brain tumors that are appropriately managed for endocrine deficiencies, but may reduce the trajectory of height attainment. K E Y W O R D S blood pressure, brain tumors, childhood, heart rate, stimulants, weight 1 INTRODUCTION A significant number of childhood brain tumor survivors develop neurocognitive impairment, particularly attention span, processing speed, Abbreviations: BMI, body mass index; BP, blood pressure; RT, radiation treatment and working memory. 1,2 Cognitive deficits may result from effect of radiation and chemotherapy on the brain, or due to the direct tumor effect. 3 Latter may represent involvement of eloquent areas of brain by the tumor or disruption of brain connectivity. Younger age and radiation treatment (RT) are the most important risk factors for cognitive impairment in childhood brain tumor survivors, and may be related to loss of gray and white matter volume. 1,2,4,5