哌甲酯治疗前后注意缺陷多动障碍患儿视觉P300和非匹配负波的变化

目的 探讨注意缺陷多动障碍(ADHD)患儿视觉P300和非匹配负波(MMN)的异常以及哌甲酯治疗前后P300和MMN的变化.方法 应用美国脑电生理仪,检测41例未服药ADHD患儿和(ADHD组)35例健康儿童(NC组)的P300和MMN,对ADHD患儿给予哌甲酯(10～16 mg.d-1,口服,平均12mg·d-1)治疗.治疗0.5a,对36例ADHD患儿进行随访,复查P300和MMN,按照国际脑电图学会标准,在检查前停服哌甲酯3～7d.结果 1.ADHD患儿P300-N2潜伏期和P3靶潜伏期[(275±21)ms、(340±20) ms]均长于NC组[(259±17) ms、(327±16) ms],二组比较差异有统计学意义(Pa＜0.01)；P300-P3靶波幅低于NC组[(3.0±1.8) μVvs (5.2±1.5) μV,P＜0.05].2.与NC组比较,ADHD患儿MMN潜伏期后移[(199±20) mavs (180±23) ms,P＜0.01],波幅降低[(3.2±1.5)μVvs(5.6±1.7) μV,P＜0.01].3.经哌甲酯治疗0.5a,ADHD患儿随多动症状改善,P300-N2潜伏期[治疗前(275 +21) ms vs治疗后(261±19) ms,P＜0.01]和P3靶潜伏期均缩短[治疗前(340 +20) ms,治疗后vs(329±19)ms,P＜0.05],P3靶波幅升高[治疗前(3.0±1.8) μVvs治疗后(4.7±2.0)μV,P＜0.01].结论 ADHD患儿视觉P300和MMN存在变异.经哌甲酯治疗后,ADHD患儿脑诱发电位有一定变化,提示ADHD患儿注意缺陷等症状可以通过哌甲酯治疗得以改善.

Changes of Visual P300 and Mismatch Negativity of Patients with Attention Deficit Hyperactivity Disorder before and after Methylphenidate Treatment

Objective To assess the characteristics of visual P300 and mismatch negativity(MMN) of patients with attention deficit hyperactivity disorder(ADHD) before and after methylphenidate treatment. Methods 1.Forty-one ADHD patients(ADHD group),35 healthy children(NC group) were selected in this study.Optical P300 and mismatch negativity of them were tested,using an American Instrument.All ADHD patients received methylphenidate treatment(10-16 mg·d-1,take orally,average 12 mg·d-1).Thirty-six ADHD patients were followed up after 6 months treatment,Optical P300 and MMN were examined.According to the international society of EEG stan-dards,ADHD patients stopped to take methylphenidate 3 to 7 days before examing. Results 1.Compared with NC group,ADHD patients showed significantly prolonged N2/P300 latency [ADHD group:(275±21) ms,NC group(259±17) ms,P<0.01]and P3/P300 latency[ADHD group:(340±20) ms,NC group:(327±16) ms,P<0.01],decreased P3/P300 amplitude [ADHD group:(3.0±1.8) μV,NC group:(5.2±1.5) μV,P<0.05].2.Compared with NC group,ADHD patient showed prolonged MMN latency[ADHD group:(199±20) ms,NC group:(180±23) ms,P<0.01] and decreased MMN amplitude[ADHD group:(3.2±1.5) μV,NC group:(5.6±1.7) μV,P<0.01].3.Compared with the baseline,ADHD patients showed shortened N2/P300 latency[before treatment:(275±21) ms,after treatment:(261±19) ms,P<0.01] and P3/P300 latency[before treatment:(340±20) ms,after treatment:(329±19) ms,P<0.05],increased P3 amplitude after medication of methylphenidate[before treatment:(3.0±1.8) μV,after treatment:(4.7±2.0) μV,P<0.01]. Conclusions Abnormal optical P300 and MMN would be found in ADHD patients.And optical P300 variations before and after medication suggested that attention deficit of ADHD patients might be improved through methylphenidate treatment.