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Geir Ogrim: Grants for innovation project in Østfold Hospital trust Norway: A clinical method for predicting effects of stimulants in pediatric ADHD

News: Sep 20, 2017

About the author: Neuropsychologist PhD Geir Øgrim is working in the neuropsychiatric team, child and adolescent psychiatry, Sykehuset Østfold (Østfold Hospital Trust), Norway, combining clinical work and research. He is a member of the research group at GNC.

ADHD is a common disorder. In Norway about 3% of children and adolescents are diagnosed with ADHD, combined or inattentive subtype. Approximately 75-80% of them are treated with medication, most often based on methylphenidate (MPH). 25-30% have negative or marginal effects of the treatment, and side effects, usually manageable, are found in 30% or more. Methods for predicting clinical gains and side effects have so far not proven to be clinically useful (Johnstone 2015).

Our research:
For more than ten years we have used EEG based methods in ADHD focusing on 1) supplementary biomarkers for the diagnosis, and 2) searching for predictors of medication response (references below). The predictors of medication response are extracted from two test sessions, each lasting one hour, the last one on a single dose of MPH. Both tests are completed before onset of a systematic four weeks trial. EEG is registered during 3 min. eyes closed, 3 min. eyes opened and during a 20 min. visual go/no-go task from which behavioral data (omission errors, reaction time etc.) and Event Related Potentials (ERPs) are extracted. Conclusions of effects; responders (REs) vs. non-responders, and side effects (SEs) vs. no side effects are based on rating scales and interviews involving parents, teachers and patients. In our analyses we compare REs and non-REs, SEs and no-SEs on parameters from test 1 and test 2. Variables that significantly discriminate between compared groups with effect sizes (ES) >0.5 are weighted according to ES and combined into two global indexes, one for predictions of clinical gains and one for side effects. We made separate analyses for the young group (8-12 years) and the older group (13-18 years). Large effect sizes were found for these global indexes; Cohen’s d about 2 for clinical gains and about 1 for side effects.

The innovation project:
Based on positive experiences with clinical application of these methods in our small clinic, we applied for grants for a one-year project offering this procedure to all children in Østfold county who are 1) diagnosed with ADHD and 2) a medication trial with stimulants is planned (N=100 or more). Patients with an ongoing medication experiencing negative effects or questionable gains are also invited. Participation is of course voluntary and the professionals responsible for the patients at the local clinics are free to use our advice/predictions as they prefer. The aim of the project is to find the right medication (or no medication) for the patients without completing the present time consuming trial and error methods. We hope to gain more knowledge on EEG/ERP based patterns within ADHD predicting the best responders to medications that are not based on MPH.

The costs of the project is 1.3 mill Norwegian kroner (NOK), including external grants from Helse Sørøst = 720.000 NOK.

Geir Øgrim
1) Johnston B.A., Coghill, D., Matthews, K.,  & Steele, J.D. (2015). Predicting methylphenidate response in attention deficit hyperactivity disorder: A preliminary study. Journal of Psychopharmacology, 29(24 –30.

2) Ogrim, G., Aasen, I.E., & Brunner, J.F. (2016). Single-dose effects on the P3no-go ERP component predict clinical response to stimulants in pediatric ADHD. Clinical Neurophysiology, 127, 3277-3287.

3) Ogrim, G., Kropotov, J., Brunner, J.F., Candrian, G., Sandvik, L., & Hestad, K.A. (2014). Predicting the clinical outcome of stimulant medication in pediatric attention-deficit/hyperactivity disorder: data from quantitative electroencephalography, event-related potentials, and a go/no-go test. Neuropsychiatric Disease and Treatment, 10, 231-242.

4) Ogrim, G., Hestad, K.A., Brunner, J.F., & Kropotov, J. (2013). 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. Neuropsychiatric Disease and Treatment, 9, 1301-1309.

5) Under review:
Ogrim G, Kropotov J: Predicting clinical outcome and side-effects of stimulant medication in pediatric Attention-deficit/hyperactivity disorder applying EEG based measures



BY: Geir Ogrim

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