Dikkat eksikliği ve hiperaktivite bozukluğu olan çocuklarda metilfenidat tedavisinin kalp hızı değişkenliği üzerine etkisi

Amaç: Bu çalışmanın amacı dikkat eksikliği ve hiperaktivite bozukluğu olan çocuklarda hastalığın ve metilfenidat kullanımının otonomik fonksiyon bozukluğu üzerine etkilerini kalp hızı değişkenliği kullanılarak belirlemektir.Gereç ve Yöntem: Dikkat eksikliği ve hiperaktivite bozukluğu tanılı tedavi almayan hastalar (n=99, üç aydır metilfenidat tedavisi alan hastalar (metilfenidat grubu) (n=100) ve yaş ve cinsiyet yönünden benzer 125 sağlıklı çocuğun kalp hızı değişkenliği parametreleri karşılaştırıldı. Elektrokardiyografik veriler supin pozisyonda 200 kalp atımının kayda alınması ile elde edildi ve kayıtlar PC-based ECG acquisition system (PC-ECG 1200) de toplanarak değerlendirildi. Bulgular: Ortalama NN intervallerinin standart sapmasında (SDNN) ve ardışık NN aralıklarının farklılıklarının karelerinin toplamının karekökünün (RMSSD) hem ilaçsız dikkat eksikliği ve hiperaktivite bozukluğu hem de metilfenidat grubunda kontrol grubuna göre düşük olmakla birlikte sadece metilfenidat grubunda diğer iki gruba göre anlamlı derecede düşük olduğu belirlendi. İlaçsız dikkat eksikliği ve hiperaktivite bozukluğu ve metifenidat grubunda LF değerinin daha yüksek olduğu ve bu yüksekliğin metilfenidat grubunda kontrol grubuna göre anlamlı olduğu görüldü.Sonuç: Dikkat eksikliği ve hiperaktivite bozukluğu olan çocuklarda otonomik disfonksiyonu gösteren parasempatik aktivitenin azaldığı ve metilfenidat kullanan hastalarda da bu azalmanın belirgin olduğu saptanmıştır. Bu nedenle metilfenidat kullanan hastalarda aritmi ve ani kardiyak ölüm gibi kardiyovasküler riskler açısından dikkatli olunmalıdır.

Anahtar Kelimeler:

Dikkat eksikliği ve hiperaktivite bozukluğu, kalp hızı değişkenliği, Methylphenidate

Effect of methylphenidate treatment on heart rate variability in children with attention-deficit hyperactivity disorder

Purpose: The aim of the present study is to determine the effect of attention deficit and hyperactivity disorder and the use of methylphenidate for its treatment on autonomic function dysfunction by using heart rate variability.Material and Methods: Parameters of untreated attention deficit and hyperactivity disorder patients (n=99), patients who have been on MPH treatment for last three months methylphenidate group) (n=100) and 125 healthy children similar age and sex were compared. Electrocardiographic data were obtained by recording 200 heart beats in supine position, and records were collected with PC-based ECG acquisition system (PC-ECG 1200) and evaluated. Results: Mean standard deviation of NN interval (SDNN) and root mean square of the successive differences (RMSSD) were lower both in untreated attention deficit and hyperactivity disorder and methylphenidate groups compared to control groups, but only in methylphenidate group, it was significantly lower. It was also determined that LF values were higher in both untreated attention deficit and hyperactivity disorder and methylphenidate groups and the difference between methylphenidate group and controls were statistically significant. Conclusion: In children with attention deficit and hyperactivity disorder, parasympathetic activity decreased, indicating autonomic dysfunction and this decrease was more marked in patients on methylphenidate. Therefore, in patients using methylphenidate, care should be exercised for cardiovascular risks such as arrhythmia and sudden cardiac death.

Keywords:

Attention-Deficit Hyperactivity Disorder, Heart Rate Variability, Methylphenidate,

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1. Spencer TJ, Biederman J, Mick E. Attention- deficit/hyperactivity disorder: diagnosis, lifespan, comorbidities, and neurobiology. J Pediatr Psychol. 2007;32:631-42.
2. Shaw M, Hodgkins P, Caci H, Young S, Kahle J, Woods AG et al. A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment. BMC Med. 2012;10:99.
3. Wolraich M, Brown L, Brown RT, DuPaul G, Earls M, Feldman HM et al. Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128:1007-22.
4. Buchhorn R, Conzelmann A, Willaschek C, Störk D, Taurines R, Renner TJ. Heart rate variability and methylphenidate in children with ADHD. Atten Defic Hyperact Disord. 2012;4:85-91.
5. Arcieri R, Germinario EA, Bonati M, Masi G, Zuddas A, Vella S et al. Cardiovascular measures in children and adolescents with attention-deficit/hyperactivity disorder who are new users of methylphenidate and atomoxetine. J Child Adolesc Psychopharmacol. 2012;22:423–31.
6. Buchhorn R, Muller C, Willaschek C, Norozi K. How to predict the impact of methylphenidate on cardiovascular risk in children with attention deficit disorder: methylphenidate improves autonomic dysfunction in children with ADHD. ISRN Pharmacol. 2012;2012:170935
7. Mick E, McManus DD, Goldberg RJ. Meta-analysis of increased heart rate and blood pressure associated with CNS stimulant treatment of ADHD in adults. Eur Neuropsychopharmacol. 2013;23:534-41.
8. Dalsgaard S, Kvist AP, Leckman JF, Nielsen HS, Simonsen M. Cardiovascular safety of stimulants in children with attention-deficit/hyperactivity disorder: a nationwide prospective cohort study. J Child Adolesc Psychopharmacol. 2014;24:302-10.
9. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996;17:354-81.
10. Vaseghi M, Shivkumar K. The role of the autonomic nervous system in sudden cardiac death. Prog Cardiovasc Dis. 2008;50:404-19.
11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, American Psychiatric Publishing. 2013.
12. Lombardi F, Makikallio TH, Myerburg RJ, Huikuri HV. Sudden cardiac death: role of heart rate variability to identify paitents at risk. Cardiovasc Res. 2001;20:210-17.
13. Lamberti M, Italiano D, Guerriero L, D'Amico G, Siracusano R, Ingrassia M et al. Evaluation of acute cardiovascular effects of immediate-release methylphenidate in children and adolescents with attention-deficit hyperactivity disorder. Neuropsychiatr Dis Treat. 2015;11:1169-74.
14. Gould MS, Walsh BT, Munfakh JL, Kleinman M, Duan N, Olfson M et al. Sudden death and use of stimulant medications in youths. Am J Psychiatry. 2009;166:992-1001.
15. Singh RB, Kartik C, Otsuka K, Pella D, Pella J. Brain-heart connection and the risk of heart attack. Biomed Pharmacother. 2002;56:257–65.
16. Kim HJ, Yang J, Lee MS. Changes of heart rate variability during methylphenidate treatment in attention-deficit hyperactivity disorder children: a 12-week prospective study. Yonsei Med J. 2015;56:1365-71.
17. Negrao BL, Bipath P, van der Westhuizen D, Viljoen M. Autonomic correlates at rest and during evoked attention in children with attention-deficit/ hyperactivity disorder and effects of methylphenidate. Neuropsychobiology. 2011;63:82-91.
18. Malliani A, Lombardi F, Pagani M. Power spectrum analysis of heart rate variability: a tool to explore neural regulatory mechanisms. Br Heart J. 1994;71:1-2.
19. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996; 93:1043-65.