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Methylphenidate increased regional cerebral blood flow in subjects with attention deficit/hyperactivity disorder
1Department of Neuropsychiatry, Seoul National University Hospital, Korea. shaywitz@unitel.co.kr
Insights
Methylphenidate (MPH) treatment increased regional cerebral blood flow (rCBF) in the frontal lobes, caudate nuclei, and thalamus of children with attention deficit/hyperactivity disorder (ADHD). This suggests MPH may correct underlying brain dysfunction in ADHD patients.
Area of Science:
- Neuroscience
- Radiology
- Pediatric Psychiatry
Background:
- Attention deficit/hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder.
- The fronto-striato-thalamic circuit is implicated in the pathophysiology of ADHD.
- Understanding the neurobiological effects of stimulant medication is crucial for effective treatment.
Purpose of the Study:
- To investigate the effects of methylphenidate (MPH) on regional cerebral blood flow (rCBF) in children with ADHD.
- To determine if MPH treatment normalizes rCBF in brain regions associated with ADHD.
- To correlate changes in rCBF with clinical response to MPH.
Main Methods:
- Utilized 99mTc-HMPAO-single photon emission computed tomography (SPECT) to measure rCBF.
- Studied 32 male children diagnosed with ADHD (DSM-IV criteria).
- Employed image subtraction and region of interest (ROI) analyses before and after MPH treatment.
Main Results:
- MPH treatment led to increased rCBF in the frontal lobes, caudate nuclei, and thalamus.
- A significant correlation was observed between SPECT findings and clinical response (77.1% matching rate).
- Specific ROIs including prefrontal, caudate, and thalamic areas showed significant rCBF increases.
Conclusions:
- Methylphenidate (MPH) positively affects the fronto-striato-thalamic circuit in children with ADHD.
- MPH treatment may help correct the underlying brain dysfunction associated with ADHD.
- SPECT imaging can provide objective evidence of MPH's therapeutic effects on brain function.
Abstract:
The regional cerebral blood flow (rCBF) responses to methylphenidate (MPH) treatment were examined in children with attention deficit/hyperactivity disorder (ADHD). Thirty-two male children, diagnosed with ADHD by the DSM-IV diagnostic criteria, other behavioral assessment scales and neuropsychological battery, were studied using 99mTc-HMPAO-single photon emission computed tomography (SPECT). Subjects were studied before and after MPH treatment. First, using an image subtraction method, we obtained a NDR parametric image of each patient and found increased cerebral blood flow in the frontal lobes, caudate nuclei and thalamic areas after treatment. When the changes in SPECT and clinical response were compared, the matching rate, sensitivity and specificity between them were found to be 77.1, 80.0 and 79.2%, respectively. Second, three transaxial brain slices delineating anatomically defined regions of interest (ROI) at 20, 40, and 60mm above the orbitomeatal line (OML) were used, with the average number of counts for each region of interest normalized to the area of the cerebellar maximal uptake. The left and right prefrontal areas, and caudate and thalamic areas showed significant increases in rCBF after MPH treatment. These findings suggested MPH could affect the function of the fronto-striato-thalamic circuit, which is known as the pathophysiologic site of ADHD and could be used to correct the underlying brain dysfunction of ADHD.