Question: I have Traumatic Brain Injury. Specifically: Diffuse Axonal Shearing Injury and Right Frontal Lobe Lesion. The injuries were sustained in a motor vehicle collision of two vehicles head on travelling approximately 45 mph in opposite directions. I was rendered unconscious and helicoptered to a hospital, where I remained unconscious to semi-conscious for a month; with internal bleeding in my skull. Doctors thought the bleeding in my brain would be fatal and were prepared to remove my organs for donation. I survived. After the month, I was transferred to a Brain Injury Unit at South Side Hospital where I was diagnosed as having cognitive deficits in attention, memory and executive functions.
I continue to suffer cognitive deficits. My life has only recently improved with the treatment of methylphenidate ER. I started on Methylphenidate ER 54mg AM and 54mg PM. That dosage was not sufficient to produce any productivity in my life. When increased to (2) 54mg AM and (2) 54mg PM I began to show more interest in activities of daily living, have more attention when talking with people, get interviews for jobs and second interviews, and finally, after 5 years, get a job.
I accredit my getting the job to the treatment on Methylphenidate. My attention to the interviewer during the job interview was improved from a cognitive deficit that clearly appears as aloof and unresponsive. That improvement is needed for my employment.
I have determined I need another increase to be effectively employed. During the employment orientation, I found myself listening and looking at the speaker, and my mind was a complete blank; lost in somewhere elsewhere....looking and listening, but not comprehending, retaining, remembering or learning. That defect must be addressed. I tried to pay attention but was unable. My mind simply would not concentrate, even while I directed my attention, senses, and intentions.
I tolerate Methylphenidate ER well. However, there is not the remarkable improvement I need from the dosage I am treated with.
I remember from my medical history that Methylphenidate IR had more effect on my "competence" in comprehending, attention, learning, and memory; as well as "executive function" or 'thinking'.
I have noticed the attention problems before. For instance, while reading, my eyes would read, and I would recognize and interpret the text, however, the cognition and instant short term memory of what I just read would be fleeting.
It has a lot to do with memory as well as attention deficits; both of which are reported as being effectively treated with Methylphenidate, in cases of Traumatic Brain Injury.
Aricept and Namenda work on medium to long range memory. They don't effectively treat short term memory.
I take simple Brain Exercises on my computer and score very poorly on memory section. I cannot remember a string of fruits displayed only seconds before being asked to specify the order they were presented.
The memory problem is treatable with Methylphenidate. I have read reports and experienced improvements in short term memory while being treated with Methylphenidate. With increase in dosage, there is improvement in memory, attention, and thinking, or making better decisions with the ability to comprehend the information being directed toward oneself, in order to be able to base those decisions on appropriate and reasonable grounds. That is my claim for why I need an increase in Methylphenidate.
1. What do you recommend?
2. Would you concur if my neurologist added Methylphenidate 20mg every 3 hours to my treatment plan?
I am currently on the following medications:
Methlyphenidate ER (2) 54mg am and (2) 54mg pm
Aricept 10mg am and 10 mg pm
Namenda 28mg 1 nightly
Clozapine 325mg at night
Topiramate 100mg at night
Buproprion 75 mg 2 times a day

I have been on MPH or AMPH for over 5 years. I have medical records lasting 5 years. My traumatic brain injury was sustained 8/7/2003.
I began neurologic care about 5-6 years ago, after researching my condition and the benefits and risks of treatment. I have MRI's, Neurotrax Mindstream Assessment reports showing remarkable cognitive deficits in attention, memory and executive function. I have cardiology report. I have eeg. If you need any, to form a better opinion let me know.
I am not asking you for a prescription. I am interested in having support for my own neurologist to move forward on my treatment needs.
XXXX

I am not prone to seizures. I am in good health. I prefer "quality" of life than to exist in a secondary cognitive state of mind.

I had been receiving (3) 20 mg Ritalin every 2 hours in the past. I think I uploaded record of that.
And, previous to my current treatment plan, I was on Vyvanse 140mg am and 140mg pm; along with Ritalin 20mg 4 times a day.

I think that the Methylphenidate ER 54mg (2) am and (2) pm is the equivalent replacement for the Vyvanse 70mg (2) am and (2) pm. However, if so, I am then being treated with less medication than before, because I had also been on Ritalin IR 20mg 4 times a day.

What other medications are available for my condition? Is there another medication that is more effective than Methylphenidate?
What is your opinion on use of medical marijuana for treatment of TBI? Have you done any research on that subject?