Díaz-Heijtz R
Neuropediatric Unit, Department of Womand and Child Health, Astrid Lindgren Children Hospital, Karolinska Institutet, Stockholm, Sweden.
Rev Neurol. 2002 Feb;34 Suppl 1:S78-81.
Attention deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder, which is very common among the school aged population. Its core symptoms are inattention, hyperactivity, and impulsivity. Currently, three principal subtypes of ADHD are recognized: ADHD predominantly inattentive type, ADHD predominantly hyperactive/impulsive type or ADHD combined type. Affected individuals have increased comorbidity risks, often followed by cognitive, emotional and/or social impairments as adults. Stimulants drugs such methylphenidate (Ritalin) or D amphetamine (Dexedrine) represent the first line drugs for the treatment of ADHD.
The clinical features of ADHD were first described by Dr. George Frederick Still for Lancet in 1902, and in spite of the investigations carried out since then, the precise cause is still not clear. The purpose of this review is to describe recent advances of the neurobiological basis of ADHD.
Recent neuroimaging studies in humans indicate a dysfunctions of the frontal striatal circuits in patients with ADHD, which can be improved by pharmacological treatment. Both pre and clinical studies implicate a dysregulation of the dopaminergic and noradrenergic systems, which are known to regulate the functions of these circuits. More recent evidence indicate that some features of ADHD could be linked to alterations in the posterior inferior vermis. These studies also stress the importance of taking into consideration factors such as age, gender and duration of pharmacological treatment when interpreting the results.
注意缺陷多动障碍（ADHD）是一种复杂的神经发育障碍，在学龄人口中非常常见。其核心症状为注意力不集中、多动和冲动。目前，ADHD主要分为三种主要亚型：以注意力不集中为主型ADHD、以多动/冲动为主型ADHD或混合型ADHD。受影响个体的共病风险增加，成年后常伴有认知、情感和/或社交障碍。兴奋剂药物如哌甲酯（利他林）或右旋苯丙胺（右旋安非他明）是治疗ADHD的一线药物。
1902年，乔治·弗雷德里克·斯蒂尔博士首次在《柳叶刀》上描述了ADHD的临床特征，尽管从那时起就进行了相关研究，但确切病因仍不清楚。本综述的目的是描述ADHD神经生物学基础的最新进展。
最近对人类的神经影像学研究表明，ADHD患者存在额叶纹状体回路功能障碍，药物治疗可改善这种情况。临床前和临床研究均表明多巴胺能和去甲肾上腺素能系统失调，已知这些系统可调节这些回路的功能。最新证据表明，ADHD的某些特征可能与小脑蚓部后下部的改变有关。这些研究还强调，在解释结果时考虑年龄、性别和药物治疗持续时间等因素的重要性。
