ADHD患児とその保護者の服薬アドヒアランス調査

【目的】注意欠如・多動症（ADHD）の患児とその保護者が薬物治療をどのように評価し，治療に向き合っているのかを明らかにする。【方法】ADHDの診断を受け，メチルフェニデート徐放剤およびアトモキセチンを処方された小１から高３までの患児94 人と保護者106人に質問紙調査と半構造化面接を行った。【結果】90％以上で服薬は規則正しく行われており，薬物治療に対する肯定的な評価は，患児・保護者で約80 ～ 90％と高かった。一方で，全面的に賛成しているわけではなく，約80％の保護者が否定的な意見も持っていた．否定的評価をする要因は，保護者は副作用を含めた長期的な影響への不安，患児は服薬の煩わしさや胃腸症状が多かった。定期的な薬物治療を続けているにも関わらず，効果と不安等を天秤にかけて治療を継続することへの積極的な支持は，患児・保護者で約50 ～ 60％であった。【結論】小児では，低年齢のため客観的に自身の状況を判断し，見通しをもって治療に参加することが難しい場合がある。患児へは胃腸症状への対処を，保護者へは治療の見通しや副作用について丁寧な説明を繰り返すことによって，薬物治療への否定的評価が軽減され，服薬アドヒアランスが向上する可能性がある

Relationships between the Color-Word Matching Stroop Task and the Go/NoGo Task:Toward Multifaceted Assessment of Attention and Inhibition Abilities of Children

Both selective attention and response inhibition can be assessed through the Stroop task and the Go/NoGo task (Go/NoGo). The color-word matching Stroop task (cwmStroop) differs from the traditional Stroop task in ways that make it easy to administer, and it enables the examiners to analyze reaction time. It is expected that the cwmStroop and Go/NoGo tasks will be useful as clinical assessments for children with developmental disorders and in combination with functional magnetic resonance imaging studies. The objectives of this study were to elucidate the pattern of developmental change in cwmStroop scores and Go/NoGo scores and to determine whether and how cwmStroop scores are related to Go/NoGo scores. The subjects consisted of 108 healthy Japanese children aged 6-14 years. We found that cwmStroop and Go/NoGo scores displayed clear developmental changes between 6 and 14 years of age. The childrenʼs scores on the 2 tasks followed different developmental courses, however, and the correlation between scores on the two tasks was weak on the whole. These results indicate that the cwmStroop and Go/NoGo tasks tap different aspects of selective attention and response inhibition. Therefore it is expected that the combination of both tests will be useful in the multifaceted assessment of selective attention and response inhibition in childhood

Inhibitory Function and Working Memory in Attention Deficit/Hyperactivity Disorder and Pervasive Developmental Disorders:Does a Continuous Cognitive Gradient Explain ADHD and PDD Traits?

To clarify the relationship between attention deficit/hyperactivity disorder (AD/HD) and pervasive developmental disorders (PDD), we investigated the common features and differences of these disorders in neuropsychological profiles. The subjects were 4 groups of Japanese boys aged 6 to 15 years, categorized by diagnosis:AD/HD (n＝20), PDD with comorbid AD/HD (PDD＋:n＝16), PDD without comorbid AD/HD (PDD－:n＝8), and typically developing (n＝60). We evaluated executive function (EF) through verbal and visuospatial memory tasks, the Go/NoGo task, and the color-word matching Stroop task. We performed a categorical analysis to estimate the effects of the 3 disorders on EF and a dimensional analysis to estimate the effects of symptom scales on EF. We found that the AD/HD and PDD＋ subjects had negative effects on verbal working memory and intra-individual response variability. The severity of these impairments was positively correlated with the inattentiveness score. The subjects with a PDD＋ or PDD－ diagnosis had poorer scores on interference control;the severity of this impairment was correlated with the PDD symptom score. Impairments in visuospatial working memory were detected in the AD/HD and PDD－ groups but not in the PDD＋ group. Impairments in inhibition of the pre-potent response were noted in all 3 categories. AD/HD and PDD share neuropsychological features, though each disorder has a specific impairment pattern. Our findings partially support the idea that AD/HD and PDD are on a spectrum

Laboratory changes during adrenocorticotropic hormone therapy associated with renal calcified lesions

Background Renal calcified lesions are known as one of the complications during adrenocorticotropic hormone (ACTH) therapy for intractable epilepsy. However, laboratory changes during the therapy or laboratory features of high‐risk cases with renal calcified lesions are yet to be clarified. Methods In this study, 43 patients with West syndrome aged ≤2 years were included. We retrospectively reviewed age and body mass index at the beginning of ACTH therapy, as well as the amount of fluid intake, daily urinary volume, and laboratory data during therapy. In addition, we studied the urinary sediment of the cases with renal calcified lesions diagnosed by computed tomography. Results After initiating ACTH treatment, urinary calcium (Ca)/creatinine ratio and urinary pH increased within 2 weeks. Urinary crystals and renal tubular epithelial cells (RTECs) in urinary sediment were frequently found in most cases. Urinary Ca levels, proteinuria or frequency of urinary crystals, and number of RTECs in the urinary sediment were significantly higher in patients with epithelial casts (ECs) or hematuria than in patients without these findings. Among the seven patients who underwent abdominal CT, ECs or hematuria were found only in those with renal calcified lesions. These findings suggested that patients with ECs or hematuria were more likely to have calcified lesions. Conclusions The risk of renal calcified lesions increased after 2 weeks of ACTH treatment. Abnormal findings in urinary sediments might be an early sign of renal calcification during ACTH therapy

Significance of High-frequency Electrical Brain Activity

　Electroencephalogram (EEG) data include broadband electrical brain activity ranging from infra-slow bands (200 / 250 Hz, respectively) are particularly of note due to their very close relationship to epileptogenicity, with the possibility that they could function as a surrogate biomarker of epileptogenicity. In contrast, physiological high-frequency activity plays an important role in higher brain functions, and the differentiation between pathological / epileptic and physiological HFOs is a critical issue, especially in epilepsy surgery. HFOs were initially recorded with intracranial electrodes in patients with intractable epilepsy as part of a long-term invasive seizure monitoring study. However, fast oscillations (FOs) in the ripple and gamma bands (40-80 Hz) are now noninvasively detected by scalp EEG and magnetoencephalography, and thus the scope of studies on HFOs /FOs is rapidly expanding

Ictal Cardiorespiratory Arrest Associated with Status Epilepticus in Panayiotopoulos Syndrome

A healthy 10-year-old boy vomited during sleep and later complained of abdominal pain; he became drowsy and uncommunicative. At the nearby hospital E.R., he deteriorated rapidly, and his respiratory movements were absent with cardiac arrest. He was immediately resuscitated. Brain MRI showed no abnormalities. EEG revealed an abnormal pattern with recurrent multifocal epileptiform activity over the bilateral occipital and frontal regions during sleep. Based on the clinical/radiological findings we diagnosed Panayiotopoulos syndrome (PS), a benign form of early-onset pediatric epilepsy characterized by autonomic symptoms. Lifethreating cardiopulmonary arrest is rare in PS, but long seizure duration of PS may associate with apnea and bradycardia

ADHD患児とその保護者の服薬アドヒアランス調査

【目的】注意欠如・多動症（ADHD）の患児とその保護者が薬物治療をどのように評価し，治療に向き合っているのかを明らかにする。【方法】ADHDの診断を受け，メチルフェニデート徐放剤およびアトモキセチンを処方された小１から高３までの患児94 人と保護者106人に質問紙調査と半構造化面接を行った。【結果】90％以上で服薬は規則正しく行われており，薬物治療に対する肯定的な評価は，患児・保護者で約80 ～ 90％と高かった。一方で，全面的に賛成しているわけではなく，約80％の保護者が否定的な意見も持っていた．否定的評価をする要因は，保護者は副作用を含めた長期的な影響への不安，患児は服薬の煩わしさや胃腸症状が多かった。定期的な薬物治療を続けているにも関わらず，効果と不安等を天秤にかけて治療を継続することへの積極的な支持は，患児・保護者で約50 ～ 60％であった。【結論】小児では，低年齢のため客観的に自身の状況を判断し，見通しをもって治療に参加することが難しい場合がある。患児へは胃腸症状への対処を，保護者へは治療の見通しや副作用について丁寧な説明を繰り返すことによって，薬物治療への否定的評価が軽減され，服薬アドヒアランスが向上する可能性がある