Symptom control in children and adolescents with attention-deficit/hyperactivity disorder on switching from immediate-release MPH to OROS MPH Results of a 3-week open-label study.

AIM: The aim of this study was to assess the impact of switching from immediate-release (IR) methylphenidate (MPH) to OROS MPH (CONCERTA, a once-daily long-acting MPH formulation, in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS: Subjects with ADHD aged 6-16 (n=105),who were stably maintained on their current IR MPH regimen (10-60 mg/day), were switched to 18, 36 or 54 mg OROS MPH once daily for 21 days, depending on pre-study daily MPH dose. ADHD symptoms were assessed by parents, teachers and investigators. RESULTS: By Day 21, parent/caregiver IOWA Conners ratings had decreased from baseline by 2.7 points to 5.2 (I/O), and by 1.8 points to 5.0 (O/D). Teacher IOWA Conners ratings were maintained. Decreases in IOWA Conners ratings are indicative of ADHD symptom improvement. Approximately 75% of parents and investigators rated therapy as good or excellent. OROS MPH therapy was well tolerated. CONCLUSIONS: Switching from IR MPH to OROS MPH maintained and may have improved symptom control in children and adolescents with ADHD, during the course of this study. The changes in parent/caregiver IOWA Conners ratings suggest that OROS MPH improves symptom control in the after-school period. This is consistent with the 12-h duration of action previously demonstrated for OROS MPH.

12-month efficacy and safety of OROS MPH in children and adolescents with attention-deficit/hyperactivity disorder switched from MPH.

PURPOSE: The aim of this study was to evaluate long-term clinical treatment with OROS methylphenidate (MPH) (Concerta) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who had been previously treated with immediate release (IR) MPH. METHODS: Subjects aged 6-16 years (n=105) who were stable on IR MPH (10-60 mg/day) were switched to 18, 36 or 54 mg OROS MPH once daily for 21 days, depending on prestudy MPH dose. Subjects who benefited from OROS MPH could continue in a 12-month extension period. ADHD symptoms and treatment response were assessed by parents/caregivers and investigators. RESULTS: Out of 105 enrolled children, 101 completed the 21-day treatment phase. In all, 89 parents/caregivers (88.1%) wanted their child to continue with the study treatment into the extension phase, and 56 children (63 %) completed the 1-year trial. The parent/caregiver global assessment of satisfaction ranged from 49 to 69% during the extension phase, and 49 to 71% of investigators rated the treatment as adequate. Efficacy and satisfaction were found more commonly in patients in the older age group (10-16 years), those on a higher dose (36 mg or 54 mg) and with the predominantly inattentive ADHD subtype. OROS MPH was well tolerated. CONCLUSIONS: Children and adolescents can effectively and safely be switched from IR MPH to OROS MPH with improved symptom control and compliance.

Deficits in haptic perception and right parietal theta power changes in patients with anorexia nervosa before and after weight gain.

OBJECTIVE: Our goal was to investigate whether patients with anorexia nervosa (AN) show deficits in haptic exploration tasks before and after weight gain. METHOD: The haptic exploration tasks consisted of palpating the structure of six sunken reliefs in sequence with both hands, eyes closed. After each exploration, the structure was reproduced on a piece of paper. A 19-channel digital electroencephalogram (EEG; linked ears) was continuously recorded during rest and haptic tasks for 10 AN patients (females, mean age: 15.90) and 10 healthy controls (CO; females, mean age: 16.14). Mean spectral power density was calculated as the mean amplitude of the spectral lines of the theta band (4-8 Hz). The AN patients were examined again after weight gain (T(0) and T(1)). RESULTS: The reproductions submitted by the AN patients were of notably poorer quality than those of the CO. Reproduction quality was unchanged after weight gain and independent of body mass index and intelligence. Mean exploration time was similiar in AN patients and CO. The analysis of spectral EEG power of both groups showed significant decrease in power data in the theta frequency band during haptic exploration compared with the rest intervals. The comparison of the theta power between CO and AN patients during haptic exploration showed major differences between the groups in both T(0) and T(1). Theta power was lower in AN patients than in the CO over the right hemisphere and right parietal regions. DISCUSSION: The quality of reproduction of the haptic stimuli and the theta-power changes indicate a cortical dysfunction and deficits in somatosensory integration processing of the right parietal cortex in AN patients even after weight gain.

Haptic perception in anorexia nervosa before and after weight gain.

Haptic perception of patients with anorexia nervosa (n = 10) was analyzed in a longitudinal study (T0-T1). The haptic explorations consisted of palpating the structure of 12 sunken reliefs in sequence with both hands, eyes closed. After each exploration the structure was reproduced on a piece of paper. In the anorexia group, mean exploration time was significantly shorter than in healthy control subjects. However, the reproductions of complex stimuli submitted by the anorexia group were of notably poorer quality than those of the healthy controls. This was also observed after weight gain (T1). The results of the haptic explorations can be interpreted as a cortical dysfunction and deficits in somatosensorical integration processing in patients with anorexia nervosa. This may be due to a disorder of tactual-spatial processing in the right parieto-occipital regions.

[Haptic perception and EEG changes in anorexia nervosa]. / Haptische Wahrnehmung und EEG-Veränderungen bei Anorexia nervosa.

OBJECTIVES: We predicted that due to diminished somatosensory integrative ability, the anorectic patients would have problems reproducing haptic stimuli. In addition we sought to determine whether EEGs from anorectic patients (AN) and the healthy controls (CO) would show discrepancies between the two groups during haptic explorations in theta-power over the right parietal region. METHOD: EEG power (theta-power) data of AN (n = 13) and CO (n = 13) were analyzed during haptic exploration tasks and rest intervals. The haptic explorations consisted of palpating the structure of six sunken reliefs in sequence with both hands, eyes closed. After each exploration the structure was drawn on a piece of paper. RESULTS: The reproductions of haptic stimuli submitted by the anorectic patients were of notably poorer quality than those of the healthy controls. During rest intervals and haptic explorations, spectral power was generally lower in the AN group in comparison to the healthy controls. Significant theta-power differences between groups showed over the right parietal cortex during haptic explorations. The decrease in EEG power in the anorectic patients in the theta bands across the right parietal region during haptic exploration tasks could be interpreted as a minor activation of visuo-spatial regions. The results of the haptic explorations as well as the EEG-power changes indicate a cortical dysfunction and deficits in somatosensory integration processing in anorexia nervosa patients.