Journal of the Korean Academy of Child and Adolescent Psychiatry

대한소아청소년정신의학회 (Korean Academy of Child and Adolescent Psychiatry)
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주의력결핍 과잉행동장애 아동에서 Osmotic-Controlled Release Oral Delivery System Methylphenidate 투여가 국소 대뇌관류에 미치는 영향

A Study about Effects of Osmotic-Controlled Release Oral Delivery System Methylphenidate on Regional Cerebral Blood Flow in Korean Children with Attention-Deficit Hyperactivity Disorder

  • 양영희 (국립서울병원 소아정신과) ;
  • 황준원 (강원대학교병원 정신건강의학과) ;
  • 김붕년 (서울대학교병원 정신건강의학과) ;
  • 강혜진 (서울대학교병원 핵의학과) ;
  • 이재성 (서울대학교병원 핵의학과) ;
  • 이동수 (서울대학교병원 핵의학과) ;
  • 조수철 (국군수도병원 정신건강센터)
  • Yang, Young-Hui (Department of Child Psychiatry, Seoul National Hospital) ;
  • Hwang, Jun-Won (Department of Psychiatry, Kangwon National University Hospital) ;
  • Kim, Boong-Nyun (Department of Neuropsychiatry, Seoul National University Hospital) ;
  • Kang, Hyejin (Department of Nuclear Medicine, Seoul National University Hospital) ;
  • Lee, Jae-Sung (Department of Nuclear Medicine, Seoul National University Hospital) ;
  • Lee, Dong-Soo (Department of Nuclear Medicine, Seoul National University Hospital) ;
  • Cho, Soo-Churl (Mental Health Center, Korean Armed Forces Capital Hospital)
  • 투고 : 2015.10.06
  • 심사 : 2016.02.16
  • 발행 : 2016.03.31
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초록

Objectives: The objective of this study was to examine the effects of osmotic-controlled release oral delivery system methylphenidate on changes in regional cerebral blood flow (rCBF) in children with attention-deficit hyperactivity disorder (ADHD) using single photon emission computed tomography (SPECT). Methods: A total of 26 children with ADHD (21 boys, mean age: $9.2{\pm}2.05$ years old) were recruited. Each ADHD participant was examined for changes in rCBF using technetium-99m-hexamethylpropylene amine oxime brain SPECT before and after 8 weeks methylphenidate medication. Brain SPECT images of pediatric normal controls were selected retrospectively. SPECT images of ADHD children taken before medication were compared with those of pediatric normal controls and those taken after medication using statistical parametric mapping analysis on a voxel-wise basis. Results: Before methylphenidate medication, significantly decreased rCBF in the cerebellum and increased rCBF in the right precuneus, left anterior cingulate, right postcentral gyrus, right inferior parietal lobule and right precentral gyrus were observed in ADHD children compared to pediatric normal controls (p-value<.0005, uncorrected). After medication, we observed significant hypoperfusion in the left thalamus and left cerebellum compared to pediatric normal controls (p-value<.0005, uncorrected). In the comparison between before medication and after medication, there was significant hyperperfusion in the superior frontal gyrus and middle frontal gyrus and significant hypoperfusion in the right insula, right caudate, right middle frontal gyrus, left subcallosal gyrus, left claustrum, and left superior temporal gyrus after methylphenidate medication (p-value<.0005, uncorrected). Conclusion: This study supports dysfunctions of fronto-striatal structures and cerebellum in ADHD. We suggest that methylphenidate may have some effects on the frontal lobe, parietal lobe, and cerebellum in children with ADHD.

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