Trastorno por déficit de atención con o sin hiperactividad aislado en consulta de Neuropediatría. Serie de casos / Isolated attention deficit disorder with/without hyperactivity in clinical practice. Series of cases

El trastorno por déficit de atención e hiperactividad afecta al 5 % de los niños en edad escolar. Se presenta una serie de 82 niños con este trastorno no asociado a enfermedades neurológicas ni a discapacidad intelectual o trastorno del espectro autista, atendidos durante un período de 8 meses en Neuropediatría: 57 casos de tipo combinado, 23 de tipo inatento y 2 de predominio hiperactivo. Tiempo medio de seguimiento: 7 ± 2,8 años (rango: 4-14,6). Compartían seguimiento con Psiquiatría 16 pacientes. Nunca recibieron tratamiento por decisión parental 12 pacientes. De los 70 que recibieron, en 20, hubo demora en el inicio del tratamiento. Tiempo medio de demora: 20 meses ± 1,6 años (rango: 1 mes y 6 años). Tiempo medio de tratamiento: 44 meses ± 2,6 años (rango: 1 mes y 10,5 años). El 90 % de los pacientes (63) que iniciaron tratamiento continuaban tomándolo en la última revisión

Attention deficit disorder with hyperactivity has a high prevalence affecting 5 % of school-age children. We present a case series of 82 children with said disorder not associated with neurological diseases or intellectual disability or autism spectrum disorder, treated during a period of 8 months in a neuropediatrics clinic: 57 cases of combined type, 23 of inattentive type and 2 of overactive predominance. Average follow-up time: 7 ± 2.8 years (range: 4-14.6); 16 patients shared follow-up with Psychiatry; 12 patients never received treatment by parental decision. Of the 70 who received it, in 20 there was a delay in the start of treatment. Average delay time: 20 months ± 1.6 years (range: 1 month and 6 years). Average treatment time: 44 months ± 2.6 years (range: 1 month and 10.5 years); 90 % of the patients (63) who started treatment were under treatment at the last control

Lisdexamfetamine to improve excessive daytime sleepiness and weight management in narcolepsy: a case series

Objective: To report the successful use of lisdexamfetamine in the management of narcolepsy. Methods: Five narcoleptic patients received lisdexamfetamine, at different dosages and for different periods, for management of excessive daytime sleepiness and weight control. Results: All patients experienced improvement of excessive daytime sleepiness and lost weight without side effects. Conclusion: Lisdexamfetamine appears promising for the treatment of two of the most common symptoms of narcolepsy: excessive daytime sleepiness and weight gain.

Effects of lithium on inflammatory and neurotrophic factors after an immune challenge in a lisdexamfetamine animal model of mania

Objective: To evaluate whether an animal model of mania induced by lisdexamfetamine dimesylate (LDX) has an inflammatory profile and whether immune activation by lipopolysaccharides (LPS) has a cumulative effect on subsequent stimuli in this model. We also evaluated the action of lithium (Li) on inflammatory and neurotrophic factors. Methods: Adult male Wistar rats were subjected to an animal model of mania. After the open-field test, they were given LPS to induce systemic immune activation. Subsequently, the animals' blood was collected, and their serum levels of brain-derived neurotrophic factor and inflammatory markers (tumor necrosis factor [TNF]-α, interleukin [IL]-6, IL-1β, IL-10, and inducible nitric oxide synthase [iNOS]) were measured. Results: LDX induced hyperactivity in the animals, but no inflammatory marker levels increased except brain-derived neurotrophic factor (BDNF). Li had no effect on serum BDNF levels but prevented iNOS levels from increasing in animals subjected to immune activation. Conclusion: Although Li prevented an LPS-induced increase in serum iNOS levels, its potential anti-inflammatory effects in this animal model of mania were conflicting.

Evaluation of the response of lisdexamfetamine in children and adolescents with ADHD: quasi-experimental study / Evaluación de la respuesta de la lisdexanfetamina en niños y adolescentes con TDAH: estudio cuasiexperimental

Abstract Introduction Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. Although lisdexamfetamine dimesylate (LDX) offers a treatment alternative, clinical evidence of LDX for ADHD has not been explored in Latin American pediatric population. Objective To evaluate the LDX response in Mexican pediatric patients with ADHD. Method We designed a quasi-experimental, uncontrolled before and after study to evaluate the LDX response in patients with severe ADHD. We established a diagnosis of ADHD according to DSM-5 criteria. We formed three groups: without previous treatment (group A), in treatment with stimulant drugs (group B) or in treatment with non-stimulant drugs (group C). Prior to the start of the study, letters of consent and informed consent were signed. We evaluated the effect of LDX based on the difference between ADHD-RS scores at the beginning and after six months. Results We recruited a total of 144 patients (group A: 48 patients, group B: 57 patients, group C: 39 patients). All the groups showed a significant decrease in the mean score of ADHD-RS (Attention Deficit Hyperactivity Disorder Rating Scale) at six months (group A 37.57 vs. 22.34, p <.01), (group B 36.72 vs. 24.45; p <. 01), (group C 38.54 vs. 24.3, p <.01). Fewer than 30% of the subjects showed a significant adverse reaction, the most frequent ones being: sleep disturbance (primary insomnia) 24% and decreased appetite in 20%. Discussion and conclusion Treatment with LDX is an effective, well-tolerated pharmacological option for Mexican pediatric patients with ADHD.

Resumen Introducción El trastorno por déficit de atención con hiperactividad (TDAH) es uno de los trastornos del neurodesarrollo más comunes. Aunque el dimesilato de lisdexanfetamina (LDX) ofrece una alternativa de tratamiento, la evidencia clínica de LDX para TDAH no se ha explorado en población pediátrica latinoamericana. Objetivo Evaluar la respuesta de LDX en pacientes pediátricos mexicanos con TDAH. Método Diseñamos un estudio cuasiexperimental no controlado de antes y después para evaluar la respuesta de LDX en pacientes con TDAH grave. Establecimos el diagnóstico de TDAH de acuerdo con criterios del DSM-5. Conformamos tres grupos: sin tratamiento previo (grupo A), en tratamiento con fármacos estimulantes (grupo B) o en tratamiento con fármacos no estimulantes (grupo C). Previo al inicio del estudio se firmaron las cartas de consentimiento y asentimiento informado. Evaluamos el efecto de LDX con base en la diferencia de los puntajes de ADHD-RS al inicio y posterior a seis meses. Resultados Reclutamos un total de 144 pacientes (grupo A: 48 pacientes, grupo B: 57 pacientes, grupo C: 39 pacientes). Todos los grupos mostraron una disminución significativa en la media de puntaje de ADHD-RS (Attention Deficit Hyperactivity Disorder Rating Scale) a los seis meses (grupo A 37.57 vs. 22.34; p < .01), (grupo B 36.72 vs. 24.45; p < .01), (grupo C 38.54 vs. 24.3; p < .01). Menos del 30% de los sujetos presentó alguna reacción adversa importante, siendo las más frecuentes: alteraciones del sueño (insomnio primario) 24% y disminución del apetito en 20%. Discusión y conclusión El tratamiento con LDX es una opción farmacológica efectiva y bien tolerada para pacientes pediátricos mexicanos con TDAH.

Potential for Dependence on Lisdexamfetamine - In vivo and In vitro Aspects

Although lisdexamfetamine is used as a recreational drug, little research exists regarding its potential for dependence or its precise mechanisms of action. This study aims to evaluate the psychoactivity and dependence profile of lisdexamfetamine using conditioned place preference and self-administration paradigms in rodents. Additionally, biochemical techniques are used to assess alterations in the dopamine levels in striatal synaptosomes following administration of lisdexamfetamine. Lisdexamfetamine increased both conditioned place preference and self-administration. Moreover, after administration of the lisdexamfetamine, dopamine levels in the striatal synaptosomes were significantly increased. Although some modifications should be made to the analytical methods, performing high performance liquid chromatography studies on synaptosomes can aid in predicting dependence liability when studying new psychoactive substances in the future. Collectively, lisdexamfetamine has potential for dependence possible via dopaminergic pathway.

Potential for Dependence on Lisdexamfetamine - In vivo and In vitro Aspects

Although lisdexamfetamine is used as a recreational drug, little research exists regarding its potential for dependence or its precise mechanisms of action. This study aims to evaluate the psychoactivity and dependence profile of lisdexamfetamine using conditioned place preference and self-administration paradigms in rodents. Additionally, biochemical techniques are used to assess alterations in the dopamine levels in striatal synaptosomes following administration of lisdexamfetamine. Lisdexamfetamine increased both conditioned place preference and self-administration. Moreover, after administration of the lisdexamfetamine, dopamine levels in the striatal synaptosomes were significantly increased. Although some modifications should be made to the analytical methods, performing high performance liquid chromatography studies on synaptosomes can aid in predicting dependence liability when studying new psychoactive substances in the future. Collectively, lisdexamfetamine has potential for dependence possible via dopaminergic pathway.

Lisdexamfetamine dimesylate in the treatment of attention-deficit/hyperactivity disorder: pharmacokinetics, efficacy and safety in children and adolescents / Dimesilato de lisdexanfetamina no tratamento do transtorno do déficit de atenção e hiperatividade: farmacocinética, eficácia e segurança em crianças e adolescentes

Background: Psychostimulants (methylphenidate and amphetamines) are considered first-line therapy for attention-deficit/hyperactivity disorder (ADHD). Lisdexamfetamine dimesylate (LDX) is a new psychostimulant approved for the treatment of ADHD in Brazil. The pharmacologically active fraction, d-amphetamine, is gradually released by hydrolysis of the LDX prodrug. Objectives: To perform a systematic review of the literature of the efficacy and safety of LDX in the treatment of ADHD in children and adolescents. Methods: Medline/PubMed searches for “d-amfetamine”, “lisdexamfetamine” and “lisdexamfetamine dimesylate” were conducted including articles available from January 2000 to November 2013. Additional references were identified using references listed in those articles. Further data on LDX were requested from its manufacturer. Results: Thirty-one papers were found related to ADHD treatment in children and adolescents. Discussion: The therapeutic benefits of LDX in children with ADHD are achieved as early as 1.5 hours after its administration and last for up to 13 hours, with efficacy comparable or superior to that of other available psychostimulants. The literature also reports efficacy in long-term treatment, with safety and tolerability profiles comparable to those of other stimulants used for the treatment of ADHD. Most of the adverse events associated with LDX are considered to be mild or moderate in severity, with the most common being loss of appetite and insomnia...

Contexto: Psicoestimulantes (metilfenidato e anfetaminas) são considerados como tratamento farmacológico de primeira linha no tratamento do transtorno do déficit de atenção e hiperatividade (TDAH). O dimesilato de anfetamina é um novo psicoestimulante aprovado para uso no Brasil, cuja fração farmacologicamente ativa, a d-anfetamina, é gradualmente liberada por hidrólise da pró-droga. Objetivos Realizar uma revisão sistemática de literatura sobre eficácia e segurança da LDX no tratamento de TDAH de crianças e adolescentes. Métodos: Busca na base Medline/PubMed com os termos “d-amfetamine”, “lisdexamfetamine” e “lisdexamfetamine dimesilate”, de janeiro de 2000 até novembro de 2013. Referências adicionais foram retiradas das referências dos artigos obtidos; dados também foram obtidos do fabricante. Resultados: Trinta e um artigos foram encontrados, relacionados ao tratamento de TDAH em crianças e adolescentes. Conclusões: Os benefícios terapêuticos da LDX são obtidos em até 1,5 hora após administração e se estendem até 13 horas, com eficácia comparável ou superior à dos demais psicoestimulantes disponíveis. A literatura também documenta eficácia em longo prazo, com perfis de segurança e tolerabilidade comparáveis aos dos demais estimulantes usados no tratamento do TDAH. A maioria dos eventos adversos associados à LDX é considerada leve ou moderada quanto à gravidade, sendo os eventos mais comuns perda de apetite e insônia...