右旋哌甲酯、胍法辛及其联合用药对注意缺陷多动障碍静息态脑电图频谱功率的影响。
Effects of d-Methylphenidate, Guanfacine, and Their Combination on Electroencephalogram Resting State Spectral Power in Attention-Deficit/Hyperactivity Disorder.
作者信息
Loo Sandra K, Bilder Robert M, Cho Alexander L, Sturm Alexandra, Cowen Jennifer, Walshaw Patricia, Levitt Jennifer, Del'Homme Melissa, Piacentini John, McGough James J, McCracken James T
机构信息
University of California, Los Angeles Semel Institute, Los Angeles.
University of California, Los Angeles Semel Institute, Los Angeles.
出版信息
J Am Acad Child Adolesc Psychiatry. 2016 Aug;55(8):674-682.e1. doi: 10.1016/j.jaac.2016.04.020. Epub 2016 May 21.
OBJECTIVE
Psychostimulant medications are the gold standard of treatment for attention-deficit/hyperactivity disorder (ADHD); however, a significant minority (∼30%) of individuals with ADHD fail to respond favorably. Noradrenergic agents are increasingly used as ADHD monotherapies or adjuncts for suboptimal stimulant response, yet knowledge of their cortical effects is limited. This study is the first to examine comparative effects of guanfacine (an α adrenergic 2A agonist), psychostimulant, and their combination on resting state cortical activity in ADHD.
METHOD
The sample comprised 179 participants aged 7 to 14 years old with ADHD (113 boys, 55 girls). Participants were randomized to 1 of 3 blinded conditions: guanfacine (GUAN), d-methylphenidate (DMPH), or the combination (COMB). Electroencephalography (EEG) was performed pre-, mid-, and post-medication titration, with concomitant assessment of behavioral and cognitive functioning.
RESULTS
Analyses of spectral power measures during resting EEG suggested that each medication condition displayed a distinct profile of effects on cortical activity. Significant time effects suggested that GUAN decreased global alpha band (8-12 hertz [Hz]) power, DMPH and COMB increased centro-parietal beta band (13-21 Hz) power, and COMB resulted in decreased theta band (4-7 Hz) power. Relative to other medication groups, COMB was associated with significantly lower theta band power and DMPH with higher beta band power compared with those in the GUAN group. Medication-related changes in theta power were correlated with improvements in behavioral and cognitive functioning.
CONCLUSION
These data reveal distinct underlying medication-related effects on neural mechanisms. The COMB condition uniquely exhibited an EEG profile that was associated with improved behavioral and cognitive functioning. Clinical trial registration information-Single Versus Combination Medication Treatment for Children With Attention Deficit Hyperactivity Disorder; http://clinicaltrials.gov/; NCT00429273.
目的
精神振奋药物是治疗注意力缺陷多动障碍（ADHD）的金标准；然而，相当一部分（约30%）ADHD患者对其反应不佳。去甲肾上腺素能药物越来越多地用作ADHD的单一疗法或对兴奋剂反应欠佳时的辅助药物，但对其皮质效应的了解有限。本研究首次探讨了胍法辛（一种α肾上腺素能2A激动剂）、精神振奋药物及其联合用药对ADHD静息态皮质活动的比较效应。
方法
样本包括179名7至14岁的ADHD患者（113名男孩，55名女孩）。参与者被随机分配到3种盲法条件中的一种：胍法辛（GUAN）、右旋甲基苯丙胺（DMPH）或联合用药（COMB）。在药物滴定前、滴定中期和滴定后进行脑电图（EEG）检查，并同时评估行为和认知功能。
结果
静息EEG期间的频谱功率测量分析表明，每种药物条件对皮质活动都显示出独特的效应特征。显著的时间效应表明，GUAN降低了整体α波段（8 - 12赫兹[Hz]）功率，DMPH和COMB增加了中央顶叶β波段（13 - 21 Hz）功率，COMB导致θ波段（4 - 7 Hz）功率降低。与其他药物组相比，COMB与显著更低的θ波段功率相关，DMPH与比GUAN组更高的β波段功率相关。θ功率的药物相关变化与行为和认知功能的改善相关。
结论
这些数据揭示了与药物相关的对神经机制的不同潜在效应。COMB条件独特地表现出一种与行为和认知功能改善相关的EEG特征。临床试验注册信息 - 注意力缺陷多动障碍儿童的单药与联合用药治疗；http://clinicaltrials.gov/；NCT00429273。
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