- 學位論文
Atomoxetine與Methylphenidate對未用藥注意力不足過動症患童的長期療效之差異：數字Stroop測驗的功能性磁振造影研究
Differential chronic therapeutic effects of atomoxetine and methylphenidate on drug-naive children with attention-deficit/hyperactivity disorder: a counting Stroop functional MRI study
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摘要
研究目的：Atomoxetine和methylphenidate是台灣以及許多其他國家用於治療注意力不足過動症（Attention Deficit/Hyperactivity Disorder, ADHD）僅有的兩種藥物。雖然這兩種藥物具有相似的藥效，過去許多臨床研究指出ADHD患者對這兩種藥物的臨床反應不盡相同，顯示兩者於藥理機制上具有差異存在。為了探討藥理機制和臨床藥效之間的關係，本研究作者觀察無用藥經驗的患童在長期接受藥物治療前後，在神經心理測驗及腦部活化程度的變化，以此針對兩種藥物進行直接比較研究。 研究方法：五十位未用藥ADHD患童（年齡介於7歲至17歲）被隨機分配服用atomoxetine（n=25）或methylphenidate (n=25)，療程為十二星期。這些研究參與者在療程前後各接受一次功能性磁振造影的掃描，並同時進行數字Stroop測驗。另外，他們在每次掃描後會進行Conner’s Continuous Performance Test (CCPT)，以評估其集中性注意力和衝動性在療程前後的變化。共有二十位atomoxetine療程的參與者，和二十二位methylphenidate療程的參與者完成最終的影像的分析。 研究成果：影像分析結果發現atomoxetine療程會降低背側前扣帶迴和背側前額葉皮質的活化程度，methylphenidate療程則是提升額下葉的活化程度。另外，前者腦區活化程度的改變，與參與者在集中性注意力的進步呈現正相關，而後者則與參與者於衝動性的減輕呈現正相關。 研究結論：本研究成果推論atomoxetine和methylphenidate於長期治療後的神經變化之差異，或許是導致每位ADHD患者對這兩種藥物臨床反應不一致的原因。
並列摘要
Objective: Methylphenidate and atomoxetine are two primary medications approved for treating attention-deficit/hyperactivity disorder (ADHD). Despite comparable efficacy, clinical studies revealed a differential response of these medications, probably due to underlying distinct pharmacological mechanisms. To relate neural mechanisms to clinical efficacy, a head-to-head comparison study was conducted to discriminate changes in brain activation of drug-naive children with ADHD when performing neuropsychological tasks after long-term pharmacotherapy. Method: Fifty drug-naive children with ADHD, aged 7 to 17, were randomized to 12 weeks of treatment with methylphenidate (n = 25) or atomoxetine (n = 25). They were scanned twice using functional magnetic resonance imaging (fMRI) during the counting Stroop task, before and after treatment. Their focused attention and impulsivity were also evaluated twice by the Conner’s Continuous Performance Test (CCPT). The final sample for fMRI analysis consisted of 20 and 22 in the methylphenidate and atomoxetine groups, respectively. Results: Atomoxetine down-regulated activations in the dorsal anterior cingulate cortex and dorsolateral prefrontal cortex, which were correlated with the improvement in focused attention assessed by the CCPT. In contrast, methylphenidate up-regulated activation in the inferior frontal gyrus, which was correlated with decreasing severity of impulsivity assessed by the CCPT. Conclusions: The current findings suggest that differential chronic therapeutic effects on neuronal changes induced by atomoxetine and methylphenidate may contribute to clinical improvement.
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