Picchietti DL, Underwood DJ, Farris WA, et al. Further studies on periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder

Pediatric Neurology, Carle Clinic, Urbana, Illinois, USA.
Movement Disorders (Impact Factor: 5.68). 11/1999; 14(6):1000-7. DOI: 10.1002/1531-8257(199911)14:63.0.CO;2-P
Source: PubMed

ABSTRACT Fourteen consecutive children who were newly diagnosed with attention-deficit hyperactivity disorder (ADHD) and who had never been exposed to stimulants and 10 control children without ADHD underwent polysomnographic studies to quantify Periodic Limb Movements in Sleep (PLMS) and arousals. Parents commonly gave both false-negative and false-positive reports of PLMS in their children, and a sleep study was necessary to confirm their presence or absence. The prevalence of PLMS on polysomnography was higher in the children with ADHD than in the control subjects. Nine of 14 (64%) children with ADHD had PLMS at a rate of >5 per hour of sleep compared with none of the control children (p <0.0015). Three of 14 children with ADHD (21%) had PLMS at a rate of >20 per hour of sleep. Many of the PLMS in the children with ADHD were associated with arousals. Historical sleep times were less for children with ADHD. The children with ADHD who had PLMS chronically got 43 minutes less sleep at home than the control subjects (p = 0.0091). All nine children with ADHD who had a PLMS index of >5 per hour of sleep had a long-standing clinical history of sleep onset problems (>30 minutes) and/or maintenance problems (more than two full awakenings nightly) thus meeting the criteria for Periodic Limb Movement Disorder (PLMD). None of the control children had a clinical history of sleep onset or maintenance problems. The parents of the children with ADHD were more likely to have restless legs syndrome (RLS) than the parents of the control children. Twenty-five of 28 biologic parents of the children with ADHD and all of the biologic parents of the control children were reached for interview. Eight of twenty-five parents of the children with ADHD (32%) had symptoms of RLS as opposed to none of the control parents (p = 0.011). PLMS may directly lead to symptoms of ADHD through the mechanism of sleep disruption. Alternative explanations for the association between ADHD and RLS/PLMS are that they are genetically linked, they share a common dopaminergic deficit, or both.

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    • "Étude Diagnostic Type d'étude Méthode Population Résultats Journal Picchietti et al., 1998 [89] SMPS dans TDAH Cas-témoins Enquête, PSG 69 enfants TDAH vs. 38 témoins SMPS plus fréquent chez TDAH (11 % vs. 2,6 %) J Child Neurol Picchietti et al., 1999 [90] "
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    ABSTRACT: Le trouble déficit de l’attention/hyperactivité (TDA/H) est un trouble fréquent chez l’enfant qui persiste souvent à l’âge adulte. Des plaintes de sommeil sont fréquemment rapportées dans le TDA/H. Les liens entre sommeil et TDA/H ont fait l’objet de recherche depuis les années 1990 d’abord chez les enfants et plus récemment chez les adultes présentant un TDA/H. Des données se sont accumulées concernant une association entre le TDA/H et le syndrome des jambes sans repos (SJSR), le syndrome d’apnées obstructives du sommeil (SAOS), les hypersomnies et les troubles du rythme circadien. L’objectif de cet article est de faire une revue de ces associations et de leurs conséquences afin d’explorer de futures perspectives de prise en charge thérapeutique et de recherche scientifique.
    Médecine du Sommeil 11/2014; 11(4). DOI:10.1016/j.msom.2014.10.002
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    • "Also, ADHD separately and ADHD together with RLS have been found to be associated with sleep disorders such as insomnia and a common genetic polymorphism [79-81]. In a recent study, 64% of children with ADHD were estimated to suffer from RLS judged by their nocturnal periodic limb movement [82]. It has been shown that MPH reduces total sleep time but improves sleep quality by consolidating sleep in adults [83]. "
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    ABSTRACT: Animal studies have shown that methylphenidate (MPH) and fluoxetine (FLX) have different effects on dopaminergic and serotonergic system in the developing brain compared to the developed brain. The effects of Psychotropic drugs On the Developing brain (ePOD) study is a combination of different approaches to determine whether there are related findings in humans. Animal studies were carried out to investigate age-related effects of psychotropic drugs and to validate new neuroimaging techniques. In addition, we set up two double-blind placebo controlled clinical trials with MPH in 50 boys (10-12 years) and 50 young men (23-40 years) suffering from ADHD (ePOD-MPH) and with FLX in 40 girls (12-14 years) and 40 young women (23-40 years) suffering from depression and anxiety disorders (ePOD-SSRI). Trial registration numbers are: Nederlands Trial Register NTR3103 and NTR2111. A cross-sectional cohort study on age-related effects of these psychotropic medications in patients who have been treated previously with MPH or FLX (ePOD-Pharmo) is also ongoing. The effects of psychotropic drugs on the developing brain are studied using neuroimaging techniques together with neuropsychological and psychiatric assessments of cognition, behavior and emotion. All assessments take place before, during (only in case of MPH) and after chronic treatment. The combined results of these approaches will provide new insight into the modulating effect of MPH and FLX on brain development.
    BMC Psychiatry 02/2014; 14(1):48. DOI:10.1186/1471-244X-14-48 · 2.21 Impact Factor
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    • "Further, RLS is associated with poor performance on tasks of executive functioning (Pearson et al. 2006). Additionally, RLS and ADHD have been shown to be associated, and in youth with both disorders, iron status is more likely to be low (Picchietti et al. 1998,1999; Konofal et al. 2007; Picchietti 2007; Cortese et al. 2009). Studies using ferritin as a peripheral measure of iron stores in youth with ADHD and that include a control group are summarized in Table 1 (Konofal et al. 2007; Konofal et al. 2004; Millichap et al. 2006; Juneja et al. 2010; Menegassi et al. 2010; Donfransesco et al. 2012). "
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    ABSTRACT: Objective: Iron plays a key role in brain function, and a deficiency of iron has been implicated in various cognitive, motor, and psychiatric disorders. Because of recent evidence that iron deficiency may be related to attention-deficit/hyperactivity disorder (ADHD) and other psychiatric disorders, the goal of this study was to compare the iron status of children and youth seen in a community mental health clinic with a national sample of same-aged subjects. Methods: In this study, a consecutive series of 108 patients (79 males) referred to a community mental health clinic was compared with a National Health and Nutrition Examination Survey (NHANES) sample on measures of iron status. Wilcoxon sign rank and median tests were used to compare distributions of ferritin. Quantile regression was performed to compare the ferritin level in the two samples while adjusting for demographic differences. Chi squared (χ2) was used to compare rates of low hemoglobin in the two samples. Results: The iron status of the clinic sample, as measured by ferritin levels (median=23 μg/L), was significantly lower than that of the national sample (median=43 μg/L). After adjustment for age, gender, and race, the clinic sample was found to have 19.2 μg/L lower ferritin than the national sample (95% CI from 7.6 to 30.9, p value=0.001). There were also significantly more subjects in the clinic sample with low hemoglobin than in the national sample. There were no differences in ferritin levels between those patients in the clinic sample with and without an ADHD or other specific psychiatric diagnosis. Conclusions: The ferritin levels of children and youth in a mental health clinic sample were significantly lower than those of the same-aged subjects in a national sample. Therefore, compromised iron status may be an additional biological risk factor for cognitive, behavioral, and psychiatric problems in pediatric populations served by the community mental health clinic.
    Journal of child and adolescent psychopharmacology 03/2013; 23(2). DOI:10.1089/cap.2012.0001 · 2.93 Impact Factor
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