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社论:注意力缺陷多动障碍神经治疗中的精准医学

Editorial: Precision Medicine in Neurotherapeutics for Attention-Deficit/Hyperactivity Disorder.

作者信息

Rubia Katya

机构信息

Institute of Psychiatry, Psychology, and Neurosciences, King's College London, United Kingdom.

出版信息

J Am Acad Child Adolesc Psychiatry. 2021 Jul;60(7):813-815. doi: 10.1016/j.jaac.2020.11.013. Epub 2020 Nov 29.

Abstract

Noninvasive brain stimulation is a novel treatment avenue for attention-deficit/hyperactivity disorder (ADHD). The advantages over pharmacological treatment are relatively minimal and transient side-effects, which make it a treatment preferred by patients and parents. Neurostimulation can furthermore target key neurobiological abnormalities established over decades of neuroimaging research. Trigeminal nerve stimulation (TNS) is the only neuromodulation and device-based nonpharmacological treatment recently licensed for children with ADHD by the US Food and Drug Administration. This was based on a double-blind sham-controlled proof-of-concept trial of 4 weeks of TNS in 62 children, who showed a reduction of ADHD symptoms with an effect size of 0.5, similar to the results with second-line nonstimulant pharmacological treatment. Precision medicine approaches, such as establishing predictors of treatment response using relatively cost-effective cognitive and electrophysiological measures would be clinically very useful to screen children with ADHD for whom TNS is likely to be effective.

摘要

非侵入性脑刺激是治疗注意力缺陷多动障碍(ADHD)的一种新途径。与药物治疗相比,其优势在于副作用相对轻微且短暂,这使其成为患者和家长偏爱的治疗方法。此外,神经刺激可以针对几十年来神经影像学研究所确定的关键神经生物学异常。三叉神经刺激(TNS)是美国食品药品监督管理局最近批准用于治疗儿童ADHD的唯一基于神经调节和设备的非药物治疗方法。这是基于一项双盲假对照概念验证试验,对62名儿童进行了为期4周的TNS治疗,结果显示ADHD症状有所减轻,效应大小为0.5,与二线非兴奋剂药物治疗的结果相似。精准医学方法,例如使用相对经济有效的认知和电生理测量方法来建立治疗反应预测指标,对于筛选可能对TNS有效的ADHD儿童在临床上非常有用。

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