Transcranial Magnetic Stimulation Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Neurology. 2011 Feb 15;76(7):615-21. doi: 10.1212/WNL.0b013e31820c2ebd.
Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset behavioral diagnosis in which children often fail to meet age norms in development of motor control, particularly timed repetitive and sequential movements, motor overflow, and balance. The neural substrate of this motor delay may include mechanisms of synaptic inhibition in or adjacent to the motor cortex. The primary objective of this study was to determine whether transcranial magnetic stimulation (TMS)-evoked measures, particularly short interval cortical inhibition (SICI), in motor cortex correlate with the presence and severity of ADHD in childhood as well as with commonly observed delays in motor control.
In this case-control study, behavioral ratings, motor skills, and motor cortex physiology were evaluated in 49 children with ADHD (mean age 10.6 years, 30 boys) and 49 typically developing children (mean age 10.5 years, 30 boys), all right-handed, aged 8-12 years. Motor skills were evaluated with the Physical and Neurological Examination for Subtle Signs (PANESS) and the Motor Assessment Battery for Children version 2. SICI and other physiologic measures were obtained using TMS in the left motor cortex.
In children with ADHD, mean SICI was reduced by 40% (p < 0.0001) and less SICI correlated with higher ADHD severity (r = -0.52; p = 0.002). Mean PANESS motor development scores were 59% worse in children with ADHD (p < 0.0001). Worse PANESS scores correlated modestly with less SICI (r = -.30; p = 0.01).
Reduced TMS-evoked SICI correlates with ADHD diagnosis and symptom severity and also reflects motor skill development in children.
注意缺陷多动障碍（ADHD）是一种儿童期起病的行为诊断，儿童在运动控制的发展中经常不能达到年龄标准，特别是定时重复和顺序运动、运动溢出和平衡。这种运动延迟的神经基础可能包括运动皮层内或附近的突触抑制机制。本研究的主要目的是确定经颅磁刺激（TMS）诱发的测量值，特别是运动皮层的短程抑制（SICI），是否与儿童期 ADHD 的存在和严重程度以及常见的运动控制延迟相关。
在这项病例对照研究中，我们评估了 49 名 ADHD 儿童（平均年龄 10.6 岁，30 名男性）和 49 名正常发育儿童（平均年龄 10.5 岁，30 名男性）的行为评分、运动技能和运动皮层生理学，所有儿童均为右利手，年龄在 8-12 岁之间。运动技能通过物理和神经细微体征检查（PANESS）和儿童运动评估电池 2 版进行评估。使用 TMS 在左运动皮层获得 SICI 和其他生理测量值。
在 ADHD 儿童中，平均 SICI 降低了 40%（p < 0.0001），较少的 SICI 与较高的 ADHD 严重程度相关（r = -0.52；p = 0.002）。ADHD 儿童的平均 PANESS 运动发育评分低 59%（p < 0.0001）。较差的 PANESS 评分与较少的 SICI 呈适度相关（r = -.30；p = 0.01）。
减少的 TMS 诱发 SICI 与 ADHD 的诊断和症状严重程度相关，也反映了儿童的运动技能发育。
