[Differences in cerebral blood flow following risperidone treatment in children with autistic disorder]. / Otistik bozuklugu olan cocuklarda risperidon tedavisinin beyin kan akimi ile degerlendirilmesi]

OBJECTIVE: Functional changes in the brains of autistic children due to risperidone treatment and theirs relationship to the symptom clusters are yet unknown. In this autistic disorder case series we aimed to comparatively evaluate the clinical findings before and after risperidone treatment, and regional cerebral blood flow (rCBF) findings with 99mTc-hexamethylpropyleneamine oxime (HMPAO) brain SPECT. METHOD: Eleven autistic patients (age range: 6-7 years; 4 girls, 7 boys) received risperidone therapy (1.5-2.5 mg d(-1)) and were followed-up for 3 months. All the patients underwent neurologic examinations, psychometric examinations, and SPECT imaging, both at the start of risperidone treatment and 3 months after the treatment started. Clinical observations, and the observations of parents and teachers were recorded. These results were compared with cerebral perfusion indices obtained from SPECT data. RESULTS: After 3 months of treatment changes in rCBF were observed in various regions and to varying degrees. We observed relationships between clinical symptoms and pre-therapy rCBF findings, and between clinical improvement and rCBF changes. CONCLUSION: Findings in the present case series are the first to demonstrate a relationship between clinical improvement and regional perfusion patterns after risperidone treatment. We think that these findings may contribute to the understanding of the neurofunctional mechanisms and hypothetical models of autism.

Dose-related immunohistochemical and ultrastructural changes after oral methylphenidate administration in cerebrum and cerebellum of the rat.

Methylphenidate is a piperidine derivative and is the drug most often used to treat attention deficit/hyperactivity disorder of children and young adults. Our aim is to investigate dose-dependent dopamine-2 receptor and glial fibrillary acidic protein expression and ultrastructural changes of the rat brain, to demonstrate possible toxicity of the long-term and high dose use of the methylphenidate. In this study, 27 female prepubertal Wistar albino rats, divided into three different dose groups (5, 10 and 20 mg/kg) were treated orally with methylphenidate dissolved in saline solution for 5 days per week during 3 months. At the end of the third month, tissues were removed and sections were collected for immunohistochemical and ultrastructural studies. We believe that methylphenidate causes dose-related activation of the dopaminergic system in several brain regions especially in ventral tegmental area and also causing neuronal degeneration and capillary wall structural changes such as basal membrane thickness and augmentation of the pinostatic vesicle in the endothelial cells. Also, increased dose of Ritalin is inducing astrocytes hypertrophy especially astrogliosis in pia-glial membrane and this is the result of the degenerative changes in prefrontal cortex region due to high dose methylphenidate administration. The dose-related accumulation of the astrocytes in capillary wall might well be a consequence of the need for nutrition of the neuronal tissue, due to transport mechanism deficiency related to neuronal and vascular degeneration. Thus, we believe that the therapeutic dose of methylphenidate must be kept in minimum level to prevent ultrastructural changes.

[Validation of the Turkish versions of the short-form Conners' teacher and parent rating scales]. / Conners Kisa Form Ogretmen ve Ana Baba Derecelendirme Olçeklerinin Geçerligi.

OBJECTIVES: To investigate factorial and criterion validity as well as reliability of the Turkish translations of the 28-item Conners' Teacher Rating Scale (CTRS) and 48-item Conners' Parent Rating Scale (CPRS), which both measure attention deficit, hyperactivity, and conduct problems in children, through a series of studies conducted with either normal or clinical samples. METHOD: Normal sample data for the teacher and parent rating scales were collected at several elementary schools in Ankara through 2 different studies. The teacher rating scale sample consisted of 1539 pupils rated by their teachers, and the parent scale sample consisted of 954 pupils rated by their parents. The clinical sample consisted of 270 children diagnosed with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ADD), and/or conduct disorder (CD), who were rated by a child psychiatrist on a DSM-IV criteria form, as well as by their parents and teachers on the respective Conners' rating scales (CRS). The patients' clinical criteria scores related to these diagnostic categories were used to evaluate, and if necessary, to modify item content of the corresponding subscales. RESULTS: Turkish versions of the CTRS and CPRS demonstrated good internal consistency as indicated by Cronbach's alpha coefficients of .95 and .90, respectively. Factor analytical data from the normal sample studies supported the construct validity of both Turkish CRS despite non-differentiation of the conduct factor from the hyperactivity factor on the teacher scale. The clinical criteria scores suggested the necessity of adapting the item content of all the subscales, except the hyperactivity subscale. CONCLUSION: The adapted and original subscales of the CRS Turkish forms demonstrated such psychometric properties that they could be employed in assessing attention deficit and disruptive behavior disorders in Turkish children.

Use of methylphenidate for attention-deficit hyperactivity disorder in patients with epilepsy or electroencephalographic abnormalities.

Methylphenidate is commonly believed to lower seizure threshold. The safe use of methylphenidate has not been clarified in patients with attention-deficit hyperactivity disorder (ADHD) and concomitant active seizure or electroencephalographic (EEG) abnormalities. Patients with ADHD and active seizures (n = 57) and patients with ADHD and EEG abnormalities (n = 62), 6 to 16 years of age, were included in the study. The safety and efficacy of treatment with antiepilepsy drugs combined with methylphenidate were determined by assessing seizure frequency, changes in ADHD symptoms, the Conners' Rating Scales, EEG differences, and side effects. The Conners' Rating Scales, performed by parents and teachers, and mean total ADHD symptom scores at the beginning of the study and at the end were significantly different (P = .05 for the Conners' Rating Scales and P = .001 for ADHD symptom scores). Methylphenidate had a beneficial effect on EEG. Seizure frequency did not change from baseline. The side effects of methylphenidate were mild and transient Methylphenidate is safe and effective in children with ADHD and concomitant active seizures or EEG abnormalities.