Ritalin Changes Boys' Brain Structure. That's Not Necessarily a Bad Thing.

An MRI-based study shows that methylphenidate (ritalin) leads to white matter changes in the brain of boys with ADHD.

This week, a new study suggests that methylphenidate, Ritalin, changes the brains of kids with Attention Deficit Hyperactivity Disorder.

Cue a lot of nervous parents waking up in a cold sweat at 3 am. And no doubt a flurry of calls to our pediatric colleagues.

This was a small, but high-quality study, appearing in the journal Radiology.

50 boys, aged 10-12, and 48 men from age 23-40 with a psychiatrist-confirmed diagnosis of ADHD were randomized to receive methylphenidate or placebo for about 4 months. Before starting treatment, and one week after stopping treatment, they got a brain MRI with diffusion-weighted imaging. A previous report of this cohort showed clinical improvement with methylphenidate – but the important question in this study is – why.

Based on prior animal studies, the researchers hypothesized that they might see changes in white matter structure in the brain, as evidenced by differences in fractional anisotropy.

Raw fractional anisotropy data (whole brain). Not too much to see here.

What the heck is fractional anisotropy?  As a nephrologist who gets accidental calls looking for neurologists all the time… I had no idea.  But after I chatted with a few real neurologists I learned that it integrates a variety of information about white matter. More myelination increases fractional anisotropy, more structured axonal orientation also increases fractional anisotropy.

So – does methylphenidate affect fractional anisotropy? Not too much, at least in the areas the researchers were focusing on.

Over time, there was no significant change in fractional anisotropy in the entire brain or in pre-identified regions of interest. Nor was there a significant effect of methylphenidate on fractional anisotropy in those regions.

But wait there’s more. More fractional anisotropy (in boys who got methylphenidate compared to men, at least).

But… the fractional anisotropy response to methylphenidate did differ significantly between the boys and the men, such that, within the boys, fractional anisotropy increased more in response to methylphenidate than in the men.

You can see exactly where in the brain that change was most dramatic in this neat picture highlighting the left superior longitudinal fasciculus and some other areas rich in crossing fibers.

OK… I don’t need an MRI to see what you’re thinking. What does this mean?

I asked lead author Liesbeth Reneman whether, you know, increasing fractional anisotropy is a good thing in this situation.

She wrote that she can’t be sure, but that in longer follow-up, she “expect to find that the fractional anisotropy changes…are positive”.

In the end the results here should be reassuring for our patients with ADHD and especially their parents. We probably aren’t warping fragile minds too much with ritalin, and it may even be helping. For the parents of kids who have seen dramatic improvements in attention thanks to methylphenidate, this study should help them sleep a bit better at night.

This commentary first appeared on medscape.com.