Effect of methylphenidate treatment on heart rate variability in children with attention-deficit hyperactivity disorder
Abstract
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
Kaynakça
- 1. Spencer TJ, Biederman J, Mick E. Attention-deficit/hyperactivity dis¬order: 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 Ato¬moxetine. 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 atten¬tion 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 treat¬ment 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 Soci- ety 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,” Progress in Cardio- vascular Diseases. 2008;50:404-19. 11. APA. In: APA, editor: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. 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
