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LETTERS TO EDITOR  
Year : 2020  |  Volume : 62  |  Issue : 4  |  Page : 440
More evidence and attention are needed to clarify the correlation between moyamoya disease and attention deficit hyperactivity disorder


Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China

Click here for correspondence address and email

Date of Submission10-Oct-2019
Date of Decision10-May-2020
Date of Acceptance19-May-2020
Date of Web Publication27-Jul-2020
 

How to cite this article:
Yu J, Zhang J, Chen J. More evidence and attention are needed to clarify the correlation between moyamoya disease and attention deficit hyperactivity disorder. Indian J Psychiatry 2020;62:440

How to cite this URL:
Yu J, Zhang J, Chen J. More evidence and attention are needed to clarify the correlation between moyamoya disease and attention deficit hyperactivity disorder. Indian J Psychiatry [serial online] 2020 [cited 2020 Aug 13];62:440. Available from: http://www.indianjpsychiatry.org/text.asp?2020/62/4/440/291001




Sir,

We read with great interest the case report by Patra and Patnaik [1] regarding a child of moyamoya disease (MMD) presenting with intellectual decline and attention deficit hyperactivity disorder (ADHD). The authors have revealed a rare association between MMD and this cognitive deficit. It is very useful to have a better understanding of the functional and neurocognitive impairment in the pediatric MMD. However, after reading this article, we would like to highlight three important questions that it raises.

First, although the diagnosis of ADHD is mainly based on clinical symptoms and scales without objective imaging and biological experiments, scientific literatures are increasingly suggesting that the pathophysiology of ADHD involves abnormal brain structure such as basal ganglia, limbic areas, and white matter microstructure which seem to index risk for ADHD.[2],[3] Meanwhile, MMD can cause abnormal changes in such brain structures.[4],[5] Does this mean that changes in brain structure caused by MMD can explain the association between MMD and ADHD? However, there is no relevant imaging examination result presented in the article. Thus, we strongly recommend that conventionally performed functional magnetic resonance imaging and cerebral hemodynamics examines, re- and postoperatively, to provide more objective evidence for MMD complicated with ADHD.

Second, one point of controversy is whether the diminished intelligence is due to a secondary condition accompanying MMD or is directly a product of the disease process. It has been reported that patients with certain conditions such as Down's syndrome and sickle cell disease have a higher risk for moyamoya; both these diseases interfere with intelligence. In order to clarify the specific causes of mental retardation, it is necessary to exclude the corresponding complications.

In addition, it has been clearly stated that MMD is clearly related to cognitive disorders. MMD affects the cognition and daily function in pediatric patients to a greater extent than in adult patients. Thus, we should strengthen the examination of cognitive and behavioral abilities of pediatric MMD. The earlier the intervention, the better the children's intelligence, memory, executive function, and quality of life. As mentioned in the article, after the encephalo-duro-arterio-myo-synangiosis procedure, the patient got significant improvement in inattention and hyperactivity.

Acknowledgment

The author thanks all those who have helped with this manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Patra S, Patnaik A. Pediatric moyamoya disease presenting as attention deficit hyperactivity disorder: Time to pay attention. Indian J Psychiatry 2019;61:544-5.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Frodl T, Skokauskas N. Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. Acta Psychiatr Scand 2012;125:114-26.  Back to cited text no. 2
    
3.
van Ewijk H, Heslenfeld DJ, Zwiers MP, Buitelaar JK, Oosterlaan J. Diffusion tensor imaging in attention deficit/hyperactivity disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2012;36:1093-106.  Back to cited text no. 3
    
4.
Mikami T, Sugino T, Ohtaki S, Houkin K, Mikuni N. Diagnosis of moyamoya disease on magnetic resonance imaging: Are flow voids in the basal ganglia an essential criterion for definitive diagnosis? J Stroke Cerebrovasc Dis 2013;22:862-8.  Back to cited text no. 4
    
5.
Nakamizo A, Kikkawa Y, Hiwatashi A, Matsushima T, Sasaki T. Executive function and diffusion in frontal white matter of adults with moyamoya disease. J Stroke Cerebrovasc Dis 2014;23:457-61.  Back to cited text no. 5
    

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Correspondence Address:
Jincao Chen
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_611_19

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