Electrophysiological and Clinical Predictors of Methylphenidate, Guanfacine, and Combined Treatment Outcomes in Children With Attention-Deficit/Hyperactivity Disorder.
Electrophysiological and Clinical Predictors of Methylphenidate, Guanfacine, and Combined Treatment Outcomes in Children With Attention-Deficit/Hyperactivity Disorder.
复制标题
哌醋甲酯、胍法辛以及注意力缺陷/多动症儿童联合治疗结果的电生理学和临床预测因素。
DOI：
10.1016/j.jaac.2022.08.001
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发表时间：
2023
影响因子：
13.3
通讯作者：
Loo,SandraK
中科院分区：
文献类型：
--
作者：
Michelini,Giorgia;Lenartowicz,Agatha;Vera,JuanDiego;Bilder,RobertM;McGough,JamesJ;McCracken,JamesT;Loo,SandraK
目的 d-哌醋甲酯和胍法辛（一种 α-2A 激动剂）的组合已成为注意力缺陷/多动障碍 (ADHD) 儿童单一疗法的潜在替代方案，但目前尚不清楚如何预测这些治疗的反应。这项研究首次调查了治疗前的临床和脑电图 (EEG) 概况，作为随机接受这些不同药物治疗的儿童治疗结果的预测因素。方法共有 181 名 ADHD 儿童（7-14 岁；123 名男孩）完成了一项为期 8 周的随机、双盲比较研究，采用 d-哌醋甲酯、胍法辛或联合治疗。治疗前评估包括多动症、焦虑和对抗行为的评级。在包含编码、维护和检索阶段的空间工作记忆任务中，测量了位于中额叶和枕中区的皮质源的脑电图活动。分析测试了治疗前的临床和脑电图测量是否可以预测 ADHD 严重程度与治疗相关的变化。结果治疗前较高的多动冲动和对立症状以及较低的焦虑可以预测所有药物组的 ADHD 改善更大。治疗前事件相关的中额叶β功率可预测联合疗法和单一疗法的治疗结果，尽管方向不同。较弱的β调节预测联合治疗的改善，而编码和检索过程中较强的调节分别预测d-哌醋甲酯和胍法辛的改善。包括脑电图和临床测量在内的多变量模型解释了使用胍法辛和联合治疗（R2 = 0.34-0.41）的 ADHD 改善差异是单独临床测量（R2 = 0.14-0.21）的两倍。结论我们确定了 ADHD 儿童对不同药物治疗反应的治疗特异性和共同预测因子。如果重复的话，这些发现表明，汇总来自临床和大脑测量的信息可能有助于 ADHD 的个性化治疗决策。 https://clinicaltrials.gov； NCT00429273
ObjectiveThe combination of d-methylphenidate and guanfacine (an α-2A agonist) has emerged as a potential alternative to either monotherapy in children with attention-deficit/hyperactivity disorder (ADHD), but it is unclear what predicts response to these treatments. This study is the first to investigate pretreatment clinical and electroencephalography (EEG) profiles as predictors of treatment outcome in children randomized to these different medications.MethodA total of 181 children with ADHD (aged 7-14 years; 123 boys) completed an 8-week randomized, double-blind, comparative study with d-methylphenidate, guanfacine, or combined treatments. Pretreatment assessments included ratings on ADHD, anxiety, and oppositional behavior. EEG activity from cortical sources localized within midfrontal and midoccipital regions was measured during a spatial working memory task with encoding, maintenance, and retrieval phases. Analyses tested whether pretreatment clinical and EEG measures predicted treatment-related change in ADHD severity.ResultsHigher pretreatment hyperactivity-impulsivity and oppositional symptoms and lower anxiety predicted greater ADHD improvements across all medication groups. Pretreatment event-related midfrontal beta power predicted treatment outcome with combined and monotherapy treatments, albeit in different directions. Weaker beta modulations predicted improvements with combined treatment, whereas stronger modulation during encoding and retrieval predicted improvements with d-methylphenidate and guanfacine, respectively. A multivariate model including EEG and clinical measures explained twice as much variance in ADHD improvement with guanfacine and combined treatment (R2= 0.34-0.41) as clinical measures alone (R2= 0.14-.21).ConclusionWe identified treatment-specific and shared predictors of response to different pharmacotherapies in children with ADHD. If replicated, these findings would suggest that aggregating information from clinical and brain measures may aid personalized treatment decisions in ADHD.Clinical trial registration informationSingle Versus Combination Medication Treatment for Children With Attention Deficit Hyperactivity Disorder; https://clinicaltrials.gov; NCT00429273