Utilidad del hierro en el tratamiento del trastorno por déficit de atención e hiperactividad / Role of iron in the treatment of attention deficit-hyperactivity disorder

Introducción: La etiología del trastorno por déficit de atención-hiperactividad (TDAH) es multifactorial: factores genéticos, ambientales y biológicos (neurotransmisores: sistema dopaminérgico). El hierro es fundamental para un correcto funcionamiento del sistema dopaminérgico. La ferropenia es frecuente en niños con TDAH y su corrección podría ser útil como tratamiento de estos pacientes. Objetivos: Analizar la posible relación entre ferropenia y síntomas de inatención, hiperactividad e impulsividad presentes en pacientes con TDAH, así como el posible beneficio del tratamiento con hierro. Pacientes y métodos: Estudio prospectivo en niños diagnosticados de TDAH según criterios DSM-IV, cognitivamente normales, no anémicos. Se usaron escalas específicas (SNAP-IV, EDAH) y se determinó la ferritina sérica. Aquellos con ferritina ≤ 30 ng/ml recibieron tratamiento con sulfato ferroso (4 mg/kg/día) durante 3 meses, analizándose posteriormente su eficacia. Resultados: Se analizó a 60 pacientes, edad media: 9,02 años (rango: 6-14). El subtipo inatento fue el más frecuente (53,3%); el 63,3% presentó ferropenia, siendo más frecuente entre los inatentos (38 vs. 22; p < 0,02). Diecisiete pacientes completaron el tratamiento con hierro. De los 8 del subtipo no inatento, en 7 el tratamiento no fue efectivo y en uno la respuesta fue parcial. De los 9 del subtipo inatento, el tratamiento fue eficaz en el control total de los síntomas en 5, parcialmente eficaz en 3 e ineficaz en un paciente. La probabilidad de obtener respuesta completa tras tratamiento con hierro fue mayor en pacientes con TDAH inatento (p = 0,02). Conclusiones: El tratamiento con suplementos férricos puede ser una alternativa eficaz en el tratamiento de pacientes con TDAH y ferropenia, especialmente en aquellos con subtipo inatento (AU)

Introduction: The aetiology of attention deficit hyperactivity disorder (ADHD) is attributed to different factors: genetic, environmental, and biological (neurotransmitters: dopaminergic system). Iron is essential for the correct functioning of the dopaminergic system. Iron deficiency is common in patients with ADHD, and its correction may be useful in the treatment. Objectives: To analyse a possible relationship between iron deficiency and symptoms of inattention, hyperactivity and impulsivity in ADHD patients, and the potential benefit of iron therapy. Patients and methods: A prospective study was conducted on non-anaemic and cognitively normal children, newly diagnosed with ADHD, according to DSM-IV criteria. Specific scales wereused (SNAP-IV, ADHS) and serum ferrit in was determined. Those with ferritin≤30 ng/ml were treated with ferrous sulphate (4 mg/kg/day) for 3 months, with its effect quantified being subsequently quantified. Results: A total of 60 patients, with a mean age of 9.02 years (range: 6-14), were analysed. The inattentive subtype was the most frequent one (53.3%). Almost two-thirds (63.3%) had iron deficiency, which was more frequent among the inattentive group (38 vs 22, P<0.02).The iron treatment was completed by 17 patients. The treatment was not effective in 7 of the8 non-inattentive subtypes, with a partial response in the remaining one. Of the 9 inattentive subtypes: the treatment was successful in the total control of symptoms in 5 of them, partially effective in other 3, and ineffective in one patient. The probability of complete response after treatment with iron was higher in inattentive patients with ADHD (P=0.02).Conclusions: Treatment with iron supplements can be an effective alternative to treat patients with ADHD and iron deficiency, especially the inattentive subtype (AU)

[Role of iron in the treatment of attention deficit-hyperactivity disorder]. / Utilidad del hierro en el tratamiento del trastorno por déficit de atención e hiperactividad.

INTRODUCTION: The aetiology of attention deficit hyperactivity disorder (ADHD) is attributed to different factors: genetic, environmental, and biological (neurotransmitters: dopaminergic system). Iron is essential for the correct functioning of the dopaminergic system. Iron deficiency is common in patients with ADHD, and its correction may be useful in the treatment. OBJECTIVES: To analyse a possible relationship between iron deficiency and symptoms of inattention, hyperactivity and impulsivity in ADHD patients, and the potential benefit of iron therapy. PATIENTS AND METHODS: A prospective study was conducted on non-anaemic and cognitively normal children, newly diagnosed with ADHD, according to DSM-IV criteria. Specific scales were used (SNAP-IV, ADHS) and serum ferritin was determined. Those with ferritin ≤ 30 ng/ml were treated with ferrous sulphate (4 mg/kg/day) for 3 months, with its effect quantified being subsequently quantified. RESULTS: A total of 60 patients, with a mean age of 9.02 years (range: 6-14), were analysed. The inattentive subtype was the most frequent one (53.3%). Almost two-thirds (63.3%) had iron deficiency, which was more frequent among the inattentive group (38 vs 22, P<.02). The iron treatment was completed by 17 patients. The treatment was not effective in 7 of the 8 non-inattentive subtypes, with a partial response in the remaining one. Of the 9 inattentive subtypes: the treatment was successful in the total control of symptoms in 5 of them, partially effective in other 3, and ineffective in one patient. The probability of complete response after treatment with iron was higher in inattentive patients with ADHD (P=.02). CONCLUSIONS: Treatment with iron supplements can be an effective alternative to treat patients with ADHD and iron deficiency, especially the inattentive subtype.