Predicting acute side effects of stimulant medication in pediatric attention deficit/hyperactivity disorder: data from quantitative electroencephalography, event-related potentials, and a continuous-performance test

Geir Ogrim, Knut A Hestad, Jan Ferenc Brunner, Juri Kropotov, Geir Ogrim, Knut A Hestad, Jan Ferenc Brunner, Juri Kropotov

Abstract

Background: The aim of this study was to search for predictors of acute side effects of stimulant medication in pediatric attention deficit/hyperactivity disorder (ADHD), emphasizing variables from quantitative electroencephalography (QEEG), event-related potentials (ERPs), and behavior data from a visual continuous-performance test (VCPT).

Methods: Seventy medication-naïve ADHD patients aged 7-16 years were tested with QEEG, including a go/no-go task condition (VCPT) from which behavior data and ERPs were extracted, 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 QEEG/ERP test results independently rated the patients as having no or small side effects (n = 37) or troublesome side effects (n = 33). We determined if the side effects were related to sex, age, IQ, ADHD subtype, comorbidities, clinical outcome, and variables in QEEG, ERPs, and VCPT.

Results: There was a moderate negative correlation between clinical outcome and side effects. Three variables were significantly associated with side effects in a multivariate logistic regression analysis. In the ERP independent component - contingent negative variation - which reflected action preparation and time evaluation, patients with high amplitudes (close to normal values) experienced more side effects than patients with lower amplitudes. A faster-than-normal reaction time in VCPT was associated with side effects, as was a high amplitude in an early ERP component (early visual independent component), reported to be influenced by attention, perceptual sensitivity, and anxiety.

Conclusion: The group with troublesome side effects had normal action-preparation electrical brain activity, a faster-than-normal reaction time, and an increased level of anxiety (measured by ERP) compared with the no side-effects group.

Keywords: ADHD; ERP; QEEG; go/no-go test; side effects; stimulants.

Figures

Figure 1
Figure 1
Percent of side effects in each quartile group. The number of patients in each quartile group (1, 2, 3, 4) was 17 or 18. The figure indicates that among the 18 patients with lowest scores on the side-effects index scale, only 13% had side effects. Among the 18 patients with highest scores, 91% had side effects. Note: Side effects index quartiles are based on the three variables that were statistical significant in the multivariate logistic regression model predicting side effects.
Figure 2
Figure 2
ERP component IC CNV late for SE group (thick black line), no-SE group (red dotted line), and normal controls (thin green line). At 1,100 ms after stimulus 1: controls, −2.92 μV; SE group, −2.35 μV; no-SE group, −0.98 μV. Abbreviations: ERP, event-related potential; IC, independent component; CNV, contingent negative variation; SE, side effects.
Figure 3
Figure 3
ERP IC early visual: SE group (thick black line), no-SE group (dotted red line), normal controls (thin green line). Abbreviations: ERP, event-related potential; IC, independent component; SE, side effects.

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