Predicting the clinical outcome of stimulant medication in pediatric attention-deficit/hyperactivity disorder: data from quantitative electroencephalography, event-related potentials, and a go/no-go test
Authors Ogrim G, Kropotov J, Brunner JF, Candrian G, Sandvik L, Hestad KA
Received 25 October 2013
Accepted for publication 16 December 2013
Published 3 February 2014 Volume 2014:10 Pages 231—242
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Geir Ogrim,1–3 Juri Kropotov,3–5 Jan Ferenc Brunner,3,6,7 Gian Candrian,8 Leiv Sandvik,9 Knut A Hestad3,10
1Neuropsychiatric Unit, Østfold Hospital Trust, Fredrikstad, Norway; 2National Resource Center for ADHD, Tourette's Syndrome, and Narcolepsy, Oslo, Norway; 3Institute of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; 4Institute of the Human Brain, Russian Academy of Sciences, Saint Petersburg, Russia; 5Department of Neuropsychology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland; 6Department of Physical Medicine and Rehabilitation, St Olav's Hospital, Trondheim, Norway; 7Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; 8Brain and Trauma Foundation, Chur, Switzerland; 9Oslo University Hospital, Department of Biostatistics, Epidemiology, and Health Economy, Oslo, Norway; 10Division of Mental Health, Innlandet Hospital Trust, Brumunddal, Norway
Background: We searched for predictors of the clinical outcome of stimulant medication in pediatric attention-deficit/hyperactivity disorder (ADHD), emphasizing variables from quantitative electroencephalography, event-related potentials (ERPs), and behavioral data from a visual go/no-go test.
Methods: Nineteen-channel electroencephalography (EEG) was recorded during the resting state in eyes-open and eyes-closed conditions and during performance of the cued go/no-go task in 98 medication-naïve ADHD patients aged 7–17 years and in 90 controls with the same age and sex distribution as the patients. For patients, the recording was followed by a systematic trial on stimulant medication lasting at least 4 weeks. Based on data from rating scales and interviews, two psychologists who were blind to the electrophysiological results independently rated the patients as responders (REs) (N=74) or non-responders (non-REs) (N=24). Using a logistic regression model, comparisons were made between REs and non-REs on the EEG spectra, ERPs (cue P3, contingent negative variation, and P3 no-go of the ERP waves and independent components [ICs] extracted from these waves), reaction time, reaction time variability, number of commission and omission errors, intelligence quotient, age, sex, ADHD subtype, and comorbidities.
Results: The two groups differed significantly on eight of the variables, with effect sizes (Cohen's d) ranging from 0.49 to 0.76. In the multivariate logistic regression analysis, only three of these variables were significantly associated with clinical outcome. The amplitude of the IC cue P3, which has a parietal–occipital distribution, was normal in REs but significantly smaller in non-REs, whereas the centrally distributed IC P3 no-go early was smaller in REs than in non-REs and controls. In addition, the REs had more power in the EEG theta band. A quartile-based index was calculated using these three variables. The group with the lowest scores comprised only 36% REs; response rates in the three other groups were 83%, 86%, and 89%.
Conclusion: The clinical outcome of stimulant medication was best predicted by electrophysiological parameters. The brain dysfunctions of the REs appear to be primarily associated with prefrontal lobe hypoactivation. The non-REs were deviant from the controls in parietal–occipital functions.
Keywords: ADHD, stimulants, predictions, clinical outcome, QEEG, ERP, go/no-go test
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