Dikkat Eksikliği ve Hiperaktivite Bozukluğu Olan Çocuklarda Metilfenidat’ın Elektrokardiyografik Etkilerinin Değerlendirilmesi

Öz

Son yıllarda çocuklarda ve gençlerde Dikkat Eksikliği ve Hiperaktivite Bozukluğu (DEHB) giderek artmaktadır. Metilfenidat (MPH), DEHB tedavisinde çocuk ve ergen psikiyatristler tarafından en çok tercih edilen ilaçtır. Ancak, hipertansiyon ve ritm bozuklukları gibi yan etki-ler görülebilmektedir. Bu çalışmada; MPH tedavisi sonrası elektrokardiyografik değişiklikleri araştırmayı amaçladık. DEHB tanısı konulup MPH kullanımı öncesi kardiyak değerlendirme amacıyla çocuk kardiyoloji polikliniğine yönlendirilen 41 hastanın anamnezleri, fizik muayene bulguları ve 12 derivasyonlu elektrokardiyografileri dosyalarından retrospektif olarak tarandı. Kontrol grubu ise üfürüm nedeniyle değerlendirilen ve ekokardiyografileri normal saptanarak masum üfürüm tanısı alan 30 hastadan oluşturuldu. Hasta ve kontrol gruplarının yaş ortala-maları sırasıyla 11.6±3.0 ve 11.1±3.2 yaş bulundu. Hastaların ilaç öncesi ve ilaç kullanımı sonrası çekilen EKG’leri karşılaştırıldığında yalnızca QRS aks derecesinin ilaç kullanımı ile anlamlı olarak arttığı saptandı (54.3±28.1 ve 59.2±27.8, p=0.012). İlaç kullanımı sonrası has-ta grubunun T aks derecesinin kontrol grubuna göre anlamlı olarak arttığı izlendi (44.9±15.8 ve 34.0±16.1, p=0.006). Diğer parametrelerde gruplar arasında anlamlı fark saptanmadı. Pekçok çalışmada metilfenidatın güvenli olduğu belirtilmiş olsa da özellikle aile öyküsü olan-lar ilaç kullanımı öncesi ve ilaç kullanımı sırasında klinik bulgular ve EKG ile değerlendirilmeli ve patoloji saptandığında pediatrik kardiyolog ile konsulte edilmelidir.

Anahtar Kelimeler

• Dikkat eksikliği ve hiperaktivite bozukluğu, metilfenidat, elektrokardiyografi

The Evaluation of Electrocardiographic Effects of Methylphenidate in Children with Attention Deficit Hyperactivity Disorder

Abstract

In recent years, the frequency of attention deficit hyperactivity disorder (ADHD) has been increasing both in children and adeloscents. Methylphenidate (MPH) is the most commonly preferred agent among child and adolescent psychiatrists in treatment of ADHD. But, cardiovascular adverse effects such as hypertension and rhythm disturbances can be seen in these patients. In this study, we aimed to assess the electrocardiographic changes after the treatment of MPH in patients with ADHD. The detailed medical history, findigs of physical examination and 12-lead electrocardiograms of forty one patients diagnosed with ADHD and referred to our pediatric cardiology outpatient clinic for cardiac evaluation before the usage of MPH were reviewed retrospectively. Kontrol grubu ise üfürüm nedeniyle değerlendirilen ve ekokardiyografileri normal saptanarak masum üfürüm tanısı alan 30 hastadan oluşturuldu. The patients evaluated for cardiac murmur and diagnosed to have innocent murmur after normal echocardiography constituted control group. The mean age of patient and control groups were 11.6±3.0 and 11.1±3.2 years, respectively. When the pre-treatment and posttreatment electrocardiograms of the patient group were compared, the only significant difference was a post-treatment increase in degree of QRS axis (54.3±28.1 ve 59.2±27.8, p=0.012). T axis was found higher in patient group after treatment compared to controls (44.9±15.8 ve 34.0±16.1, p=0.006). The other parameters did not differ between the groups. Although many studies reported that MPH is safe, the patients should be evaluated with clinical and electrocardiographic findings before initiation and during the use of MPH especially in patients with positive family history. They should be consulted by pediatric cardiologist if any pathology is found.

Keywords

• Attention deficit hyperactivity disorder, methylphenidate, electrocardiography

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