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Trayectorias de desarrollo de anomalías del volumen cerebral en niños y adolescentes con trastorno por déficit de
F Xavier Castellanos1, Patti P Lee, Wendy Sharp
1Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA. francisco.castellanos@med.nyu.edu
JAMA
|October 9, 2002
Resumen
Los niños con trastorno por déficit de atención e hiperactividad (TDAH) tienen volúmenes cerebrales más pequeños en todas las regiones, y estas diferencias persisten en la edad adulta. Estas trayectorias de desarrollo cerebral en el TDAH parecen fijas y no están influenciadas por la medicación estimulante.
Área de la Ciencia:
- La neurociencia es la neurociencia.
- Psicología del desarrollo Psicología del desarrollo.
- La pediatría es la medicina de los niños.
Sus antecedentes:
- El trastorno por déficit de atención e hiperactividad (TDAH) se asocia con anormalidades cerebrales reportadas, pero los estudios a menudo carecen de una metodología sólida.
- Las investigaciones anteriores tienen limitaciones que incluyen tamaños de muestra pequeños, diseños de sección transversal y no tener en cuenta los efectos de los medicamentos estimulantes.
Objetivo del estudio:
- Para comparar los volúmenes cerebrales regionales en niños y adolescentes con TDAH versus controles en la evaluación inicial y hacer un seguimiento de los cambios a lo largo del tiempo.
- Para investigar las diferencias entre los individuos medicados y no medicados con TDAH.
- Examinar las diferencias basadas en el sexo en el volumen cerebral y las trayectorias de desarrollo.
Principales métodos:
- Un estudio de casos y controles en el que participaron 152 niños y adolescentes con TDAH y 139 controles de edad y sexo.
- Se utilizaron 544 imágenes de resonancia magnética anatómica recogidas entre 1991 y 2001.
- Empleó métodos automatizados para comparar los volúmenes iniciales y los cambios relacionados con la edad en el cerebro total, el cerebelo, la materia gris y blanca y el núcleo caudado.
Principales resultados:
- Los individuos con TDAH exhibieron volúmenes cerebrales significativamente más pequeños en todas las regiones medidas en comparación con los controles, incluso después del ajuste covariado.
- Los niños previamente no medicados con TDAH mostraron notablemente menores volúmenes totales de materia cerebral, cerebelosa y blanca.
- Las anomalías del volumen cerebral en el TDAH persistieron con la edad, con trayectorias de desarrollo que permanecieron paralelas a los controles, a excepción del núcleo caudado.
- Volúmenes más pequeños en regiones específicas se correlacionaron con la gravedad de los síntomas del TDAH.
Conclusiones:
- El desarrollo cerebral en el TDAH sigue trayectorias en gran medida paralelas a los controles, lo que sugiere influencias genéticas fijas y / o ambientales tempranas.
- Estos patrones de desarrollo parecen no progresivos e independientes del tratamiento con estimulantes.
- Los hallazgos destacan la naturaleza temprana y persistente de las diferencias estructurales cerebrales en el TDAH.
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