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- Title
家族性のQT延長所見がみられたAI)HI) 児童への メチルフェニデート徐放錠の使用経験.
- Authors
井上勝夫; 石田匡宏; 宮岡 等
- Abstract
Background and purpose: Osmotic-release oral system of methylphenidate (MPH) is one of the first-line drugs for attention-deficit/ hyperactivity disorder (ADHD). It is recognized that MPH often causes loss of appetite and insomnia, and sometimes palpitation, tachycardia, or QT prolongation [seen on an electrocardiogram (ECG)] as its side effects. We present the case of an 8-year-old boy with ADHD who showed familial long QT interval and was safely treated with MPH. Method: The patient underwent his first medical examination at the age of 8 due to his hyperactivity since his toddlerhood; he had been leaving his seat and exhibiting severe inattention in his class at school and was, therefore, referred to our hospital. His condition scored 38 points under the ADHD rating scale IV and head MRI, electroencephalography and blood biochemistry examination, including thyroid function, revealed non-abnormal results. Thus, he was diagnosed with ADHD. Because his symptoms, including restlessness, did not improve with psychosocial interventions, pharmacotherapy was discussed. However, before providing the prescription, his electrocardiogram revealed a QTc interval of 469 msec (Fridericia’s correction), confirming his prolonged QT. Furthermore, it was suggested that his mother and elder sister also have long QT, but there was no family history of sudden death. To assess the risk of using MPH, we requested a pediatrician for a cardiovascular inspection. The pediatrician reported that MPH prescription would impose no risk on the child because no abnormality was detected in the analysis of his cardiac form and function using an echocardiogram, and no QT prolongation was observed in his treadmill exercise tolerance test outcomes. We discussed these findings with his mother, after which MPH treatment of 18 mg a day was initiated. Result: After the MPH administration, he stayed in his seat continuously and studied attentively. A periodical ECG examination revealed an increase in the QTc of up to 486 msec, and no circulatory symptoms, including fainting, were observed in the child. Thereafter, he continued the MPH treatment for approximately 4 years. Discussion: For children with ADHD and long QT, as in this case, it is suggested that a low-dose MPH treatment may be safely administered after a cardiovascular inspection before the treatment and periodical electrocardiography throughout the treatment period.
- Publication
Japanese Journal of Child & Adolescent Psychiatry, 2021, Vol 62, Issue 4, p610
- ISSN
0289-0968
- Publication type
Article