Wiguna Tjhin, Guerrero Anthony P S, Wibisono Sasanto, Sastroasmoro Sudigdo
Child and Adolescent Psychiatry Division, Department of Psychiatry, University of Indonesia, Jakarta, Indonesia.
Clin Neuropharmacol. 2012 Mar-Apr;35(2):81-5. doi: 10.1097/WNF.0b013e3182452572.
Recent studies on the neurobiology of attention-deficit/hyperactivity disorder (ADHD) have suggested that there is dysregulation of dopamine-mediated neurotransmission, particularly in the prefrontal cortex and basal ganglia, and that treatment with methylphenidate reverses this dysregulation. Using methodology similar to previous studies involving putative markers of brain functioning, we used 1H magnetic resonance spectroscopy to study the effect of 12-week treatment with daily 20-mg long-acting methylphenidate on the glutamate/creatine, N-acetyl-aspartate/creatine, choline/creatine, and myoinositol/creatine ratios in the prefrontal cortices of medication-naive children with ADHD.
This was a prospective study, using a pretest and posttest design, on a single group of 21 children (mean age, 8.52 years; 17 males and 4 females) with a diagnosis of ADHD. A low time echo (TE) magnetic resonance spectroscopic scans sampled voxels of interest (1.5 × 1.5 × 2.0) from both the right and left prefrontal cortices.
After treatment, the N-acetyl-aspartate/creatine ratio increased 18.8% in the right prefrontal cortex (P = 0.001) and 10% in the left prefrontal cortex (P = 0.007); the glutamate/creatine ratio decreased 15% in the right prefrontal cortex (P = 0.005) and 14.1% in the left prefrontal cortex (P = 0.005); the choline/creatine ratio decreased 12.4% in the right prefrontal cortex (P = 0.037) and 16% in the left prefrontal cortex (P = 0.006); and the myoinositol/creatine ratio decreased 14.7% in the left prefrontal cortex (P = 0.011) and 7.7% in the right prefrontal cortex (P = 0.129).
Notwithstanding the limitations of this pilot study, we found, after stimulant treatment, significant neurochemical changes (thought to reflect functional improvement and improved neuroplasticity) in the prefrontal cortices of children with ADHD.
近期关于注意力缺陷多动障碍（ADHD）神经生物学的研究表明，多巴胺介导的神经传递存在失调，尤其是在前额叶皮质和基底神经节，而哌甲酯治疗可逆转这种失调。我们采用与先前涉及脑功能假定标志物的研究相似的方法，使用氢质子磁共振波谱来研究每日20毫克长效哌甲酯治疗12周对未接受过药物治疗的ADHD儿童前额叶皮质中谷氨酸/肌酸、N - 乙酰天门冬氨酸/肌酸、胆碱/肌酸和肌醇/肌酸比值的影响。
这是一项前瞻性研究，采用单组21名被诊断为ADHD的儿童（平均年龄8.52岁；17名男性和4名女性）的前测和后测设计。低时间回波（TE）磁共振波谱扫描从左右前额叶皮质采集感兴趣体素（1.5×1.5×2.0）。
治疗后，右侧前额叶皮质中N - 乙酰天门冬氨酸/肌酸比值增加了18.8%（P = 0.001），左侧前额叶皮质中增加了10%（P = 0.007）；右侧前额叶皮质中谷氨酸/肌酸比值降低了15%（P = 0.005），左侧前额叶皮质中降低了14.1%（P = 0.005）；右侧前额叶皮质中胆碱/肌酸比值降低了12.4%（P = 0.037），左侧前额叶皮质中降低了16%（P = 0.006）；左侧前额叶皮质中肌醇/肌酸比值降低了14.7%（P = 0.011），右侧前额叶皮质中降低了7.7%（P = 0.129）。
尽管这项初步研究存在局限性，但我们发现，在兴奋剂治疗后，ADHD儿童的前额叶皮质出现了显著的神经化学变化（被认为反映了功能改善和神经可塑性增强）。
