Unitat de Recerca en Neurociència Cognitiva (Departament de Psiquiatria i Medicina Legal), Universitat Autònoma de Barcelona, Campus de Bellaterra, 08193, Barcelona, Spain,
Eur Child Adolesc Psychiatry. 2014 Sep;23(9):805-12. doi: 10.1007/s00787-013-0510-y. Epub 2014 Jan 7.
Methylphenidate (MPH) is the first choice of medical treatment for attention-deficit/hyperactivity disorder (ADHD). Its mechanism of action is to inhibit the reuptake of dopamine and noradrenaline mainly in the region of the striatum. It has been estimated that 10-30 % of patients with ADHD do not respond adequately to MPH. The aim of this study was to evaluate whether striatal differences exist between good and poor responders to MPH. The sample included 27 treatment-naïve children with ADHD between the ages of 6 and 14. MPH administration started 1 day after the MRI acquisition. After a month, psychiatrists established the good or poor response to treatment according to clinical criteria. MRI images were analyzed using a technique based on regions of interest applied specifically to the caudate and accumbens nuclei. Sixteen patients showed good response to MPH and 11 a poor one. Regions of interest analysis showed that good responders had a higher concentration of gray matter in the head of both caudate nuclei and the right nucleus accumbens. Furthermore, a significant correlation was found between caudate and accumbens nuclei volume and the Conners' Parent Rating Scale and Continuous Performance Test improvement. These results support the hypothesis of the involvement of the caudate and accumbens nuclei in MPH response and in ADHD pathophysiology.
哌醋甲酯（MPH）是治疗注意缺陷多动障碍（ADHD）的首选药物。其作用机制主要是抑制纹状体区域多巴胺和去甲肾上腺素的再摄取。据估计，10-30%的 ADHD 患者对 MPH 反应不充分。本研究旨在评估对 MPH 反应良好和反应不佳的患者纹状体是否存在差异。该样本包括 27 名年龄在 6 至 14 岁之间、未经 MPH 治疗的 ADHD 儿童。MPH 给药在 MRI 采集后 1 天开始。一个月后，精神科医生根据临床标准确定治疗的良好或不良反应。使用专门应用于尾状核和伏隔核的基于感兴趣区域的技术分析 MRI 图像。16 名患者对 MPH 反应良好，11 名患者反应不佳。感兴趣区域分析显示，良好反应者的尾状核头部和右侧伏隔核的灰质浓度更高。此外，还发现尾状核和伏隔核体积与 Conners' 父母评定量表和连续操作测试改善之间存在显著相关性。这些结果支持了尾状核和伏隔核参与 MPH 反应和 ADHD 病理生理学的假设。
