Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, PR China.
Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, PR China (Mr Fu, Ms Yuan, Ms Pei, Ms Zhang, Ms Xu, Mr Hu, Ms Xie, Ms Zhao, Dr Wang, Dr Yang, and Dr Cao).
Int J Neuropsychopharmacol. 2022 Sep 28;25(9):709-719. doi: 10.1093/ijnp/pyac028.
Although methylphenidate (MPH) and atomoxetine (ATX) can improve clinical symptoms and functional impairments in attention deficit/hyperactive disorder (ADHD), the underlying psychopharmacological mechanisms have not been clearly elucidated. Therefore, we aimed to explore the shared and unique neurologic basis of these 2 medications in alleviating the clinical symptoms and functional impairments observed in ADHD.
Sixty-seven ADHD and 44 age-matched children with typical development were included and underwent resting-state functional magnetic resonance imaging scans at baseline. Then patients were assigned to MPH, ATX, or untreated subgroups, based on the patients' and their parents' choice, for a 12-week follow-up and underwent a second functional magnetic resonance imaging scan. The treatment effect on degree centrality (DC) was identified and correlated with clinical symptoms and functional impairments in the ADHD group.
Both MPH and ATX normalized the DC value in extensive brain regions mainly involving fronto-cingulo-parieto-cerebellum circuits. However, ATX showed limited significant effects on the cerebellum compared with ADHD at baseline. The improvements in clinical symptoms were correlated with increased DC in the right inferior temporal gyrus in both MPH and ATX subgroups but showed opposite effects. The alleviation of functional impairments in the school/learning domain negatively correlated with decreased DC in the bilateral cerebellum after MPH treatment, and the family functional domain positively correlated with decreased DC in the cerebellum and negatively correlated with decreased DC in the postcentral gyrus after ATX treatment.
Both MPH and ATX can normalize abnormal brain functions that mainly involve the fronto-cingulo-parieto-cerebellum circuit in ADHD. Furthermore, the 2 medications showed shared and unique effects on brain functions to alleviate clinical symptoms and functional impairment.
虽然哌甲酯（MPH）和托莫西汀（ATX）均可改善注意缺陷多动障碍（ADHD）的临床症状和功能障碍，但潜在的精神药理学机制尚不清楚。因此，我们旨在探索这两种药物在缓解 ADHD 观察到的临床症状和功能障碍方面的共同和独特的神经基础。
纳入 67 名 ADHD 儿童和 44 名年龄匹配的发育正常的儿童，在基线时进行静息态功能磁共振成像扫描。然后根据患者及其父母的选择，将患者分为 MPH、ATX 或未治疗亚组，进行为期 12 周的随访，并进行第二次功能磁共振成像扫描。确定对度中心度（DC）的治疗效果，并与 ADHD 组的临床症状和功能障碍相关联。
MPH 和 ATX 均使广泛的脑区的 DC 值正常化，主要涉及额顶枕叶小脑回路。然而，与基线时的 ADHD 相比，ATX 对小脑的显著影响有限。临床症状的改善与右下回颞叶的 DC 增加相关，而 MPH 和 ATX 亚组均显示出相反的效果。在 MPH 治疗后，学校/学习领域的功能障碍的缓解与双侧小脑的 DC 降低呈负相关，而家庭功能领域与小脑的 DC 降低呈正相关，与后中央回的 DC 降低呈负相关。
MPH 和 ATX 均可使主要涉及 ADHD 额顶枕叶小脑回路的异常脑功能正常化。此外，这两种药物对大脑功能具有共同和独特的作用，可缓解临床症状和功能障碍。
