[ARVD-FORUM] Personal message. Dr. Johnson

[ARVD Symposium]

English - Spanish

Dear Dra. Isabel Escape from Barcelona,

Here is another option if you are concernced about methyl phenidate therapy.
Individual psychotherapy, behaviour therapy and parental counseling have a
definite role in the management of children with Attention Deficit
Hyperactivity Disorder (ADHD). Many children with mild to moderate ADHD
respond very well to behaviour modification programs. Apart from improving
attention and reducing hyperactivity, behavioural interventions with
positive reinforcement and psychotherapy increases the self esteem of the
children and adolescents with ADHD. This also helps in refining their social
skills.

Dr. Beena Johnson, MBBS, DCH, MD, FIACAM,
Consultant in Child & Adolescent Guidance,  Baby Memorial Hospital, Calicut,
Kerala, India.
& Executive Editor, Journal of Indian Association for Child and Adolescent
Mental Health
www.jiacam.org

-----------------------

Estimada Dra. Isabel Escape de Barcelona:

Aquí tiene otra opcion si esta preocupada por la terapia con metilfenidato.
La psicoterapia individual, la terapia de comportamiento y el asesoramiento
para los padres tienen un rol definitivo en el manejo de ninios con
Trastorno con Deficit de Atencion con Hiperactividad (TDAH). Muchos ninios
con TDAH leve a moderada responden muy bien a los programas de modificacion
del comportamiento. Ademas de mejorar la atencion y reducir la
hiperactividad, las intervenciones conducistas con reafirmacion positiva y
psicoterapia aumenta la autoestima de los ninios y adolescentes con TDAH.
Esto tambien ayuda a pulir sus habilidades sociales.

Dr. Beena Johnson, MBBS, DCH, MD, FIACAM,
Consultant in Child & Adolescent Guidance,  Baby Memorial Hospital, Calicut,
Kerala, India.
& Executive Editor, Journal of Indian Association for Child and Adolescent
Mental Health
www.jiacam.org

 _____________________________________
>
> English - Spanish
>
> Dear colleague Dra. Isabel Escape from Barcelona.
> Yes I confirm.  Methylphenidate is used in the treatment of
> attention-deficit/hyperactivity disorder (ADHD). ADHD are associated with
> minor, but statistically significant, changes in heart rate and blood
> pressure that were often observed in those receiving placebo. Given the
> minor
> pressor and chronotropic effect of these medications, patients with ADHD
> should have their blood pressure and heart rate checked at baseline and
> periodically during treatment. Wilens TE, Hammerness PG, Biederman J,  et
> al Blood pressure changes associated with medication treatment of adults
> with attention-deficit/hyperactivity disorder. J Clin Psychiatry.
> 2005;66:253-259.
>
> Methylphenidate-induced increases in blood pressure are in part due to its
> central dopaminergic effects.  Methylphenidate's pressor effects may be in
> part mediated by dopamine-induced increases in peripheral
> epinephrine.(Volkow
> ND, Wang GJ, Fowler JS,  et al Cardiovascular effects of methylphenidate in
> humans are associated with increases of dopamine in brain and of
> epinephrine in plasma.Psychopharmacology (Berl). 2003;166:264-270).
>
> In ARVC/D we observe catecholamines facilitation. The induction of the VT
> generally is dependent of the infusion of isoproterenol. Catecholamines
> increase the ST segment elevation.
>
> ARVC/D Type 2 an autosomal dominant pattern of inheritance mapped to the
> long arm of chromosome 1. Cytogenetics is 1q42-q43 and the OMIN number is
> 600996 is characterized by presenting as a minor or "concealed phase",
> showing PVT induced by strain. Since both loci, ARVD1 and ARVD2, were
> mapped near the alpha-actin gene, it is possible to involve it with these
> myofibrillar proteins in the pathogenesis of ARVC/D (Rampazzo A, Nava A,
> Erne P, Eberhard M, Vian E, Slomp P, Tiso N, Thiene G, Danieli GA.A new
> locus for arrhythmogenic right ventricular cardiomyopathy (ARVD2) maps to
> chromosome 1q42-q43. Hum Mol Genet. 1995;  4:2151-2154.).  A  RYR2 mutation
> has been identified in four independent families. The RyR2 protein in
> myocardial cells activated by ion calcium Ca2+ induces cation release from
> the sarcoplasmic reticulum to cytosol. The RyR2 protein is the equivalent
> to the ryanodine receptor protein of the skeletal muscle, known as RyR1.
> The skeletal muscle ryanodine receptor has a role in malignant hyperthermia
> and in susceptibility in the so-called central core disease (CCD) (Tiso N,
> Stephan DA, Nava A, et al. identification of mutations in the cardiac
> ryanodine receptor gene in families affected with arrhythmogenic right
> ventricular cardiomyopathy type 2 (ARVD2). Hum Mol Genet 2001;10:189-94.)
> (Tiso N, Bauce B, Rampazzo A, Bagattin A, Nava A, Danieli GA. Gene symbol:
> RYR2. Disease: Arrhythmogenic right ventricular cardiomyopathy type 2.Hum
> Genet. 2004; 114:405.)
> Clinically it causes PVT induced by strain or emotional adrenergic stress
> in a similar way to familial catecholaminergic PVT without structural heart
> disease (Bagattin A, Bauce B, Rampazzo A, Tiso N, Nava A, Danieli GA.Gene
> symbol: RYR2. Disease: Effort-induced polymorphic ventricular arrhythmias.
> HumGenet. 2004;114:406.).
>
> FinaI conclusion: I think that is dangeours to use Methylphenidate in first
> degree relatives of ARVD patients.
>
> You ask: would like to ask you, what is the recommended age to make studies
> on them? How frequently?. Please read Dr Marcus recomendations in this
> forum.
>
> Best
>
> Andres Perez Riera
>
> -----------------------
>
> Estimada colega, Dra. Isabel Escape de Barcelona:
> Si, se lo confirmo. El metilfenidato se emplea en el tratamiento del
> trastorno por deficit de atencion con hiperactividad (TDAH). El TDAH se
> asocia con cambios menores, pero estadisticamente significativos, en la
> frecuencia cardiaca y la presion sanguinea, que se observan con frecuencia
> en quienes reciben placebo. Dado el efecto menor presor y cronotropico de
> estos medicamentos, los pacientes con TDAH deben verificar su presion
> sanguinea y su frecuencia cardiaca en condiciones basales y periodicamente
> durante el tratamiento.
> Wilens TE, Hammerness PG, Biederman J,  et al
> Blood pressure changes associated with medication treatment of adults with
> attention-deficit/hyperactivity disorder. J Clin Psychiatry.
> 2005;66:253-259.
>
> Los aumentos de la presion sanguinea inducidos por metilfenidato se deben
> en parte a sus efectos centrales dopaminergicos. Los efectos presores del
> metilfenidato pueden ser mediados en parte por aumentos inducidos por
> dopamina en la epinefrina periferica. (Volkow ND, Wang GJ, Fowler JS,  et
> al Cardiovascular effects of methylphenidate in humans are associated with
> increases of dopamine in brain and of epinephrine in plasma.
> Psychopharmacology (Berl). 2003;166:264-270).
>
> En la M/DAVD observamos facilitacion de catecolaminas. La induccion de las
> TV generalmente depende de la infusion de isoproterenol. Las catecolaminas
> aumentan el supradesnivel del segmento ST.
>
> La M/DAVD tipo 2 presenta un patron autosomico dominante de herencia,
> mapeado en el brazo largo del cromosoma 1. La citogenetica es 1q42-q43 y el
> numero OMIM es 600996, y se caracteriza por presentarse como una "etapa
> oculta" o menor, que muestra TVP inducida por esfuerzo. Puesto que ambos
> locus, DAVD1 y DAVD2 se mapearon cerca del gene de la alfa actina, es
> posible involucrarlo con estas proteinas miofibrilares en la patogenesis de
> la M/DAVD (Rampazzo A, Nava A, Erne P, Eberhard M, Vian E, Slomp P, Tiso N,
> Thiene G, Danieli GA. A new locus for arrhythmogenic right ventricular
> cardiomyopathy (ARVD2) maps to chromosome 1q42-q43. Hum Mol Genet. 1995;
> 4:2151-2154).
> Una mutacion RYR2 se ha identificado en cuatro familias independientes. La
> proteina RyR2 en las celulas miocardicas, activada por el ion calcico Ca2+,
> induce la liberacion de cationes desde el reticulo sarcoplasmatico en el
> citosol. La proteina RyR2 es el equivalente del receptor de rianodina del
> musculo esqueletico, conocido como RyR1. El receptor de rianodina del
> musculo esqueletico tiene un papel en la hipertermia maligna y en la
> susceptibilidad en la llamada enfermedad del nucleo central (ENC) (Tiso N,
> Stephan DA, Nava A, et al. identification of mutations in the cardiac
> ryanodine receptor gene in families affected with arrhythmogenic right
> ventricular cardiomyopathy type 2 (ARVD2). Hum Mol Genet 2001;10:189-94.)
> (Tiso N, Bauce B, Rampazzo A, Bagattin A, Nava A, Danieli GA. Gene symbol:
> RYR2. Disease: Arrhythmogenic right ventricular cardiomyopathy type 2.Hum
> Genet. 2004; 114:405).
> Clinicamente, causa TVP inducida por esfuerzo o estres adrenergico
> emocional, de manera similar a la TVP catecolaminergica familiar sin
> cardiopatia estructural. (Bagattin A, Bauce B, Rampazzo A, Tiso N, Nava A,
> Danieli GA.Gene symbol:
> RYR2. Disease: Effort-induced polymorphic ventricular arrhythmias. Hum
> Genet. 2004;114:406).
>
> Conclusion final: creo que es peligroso usar el metilfenidato en parientes
> en primer grado de pacientes con DAVD.
>
> Ud. pregunta: Quisiera preguntarles a ¿que edad se recomienda  estudiarles?
> , ¿con que frecuencia? Por favor lea las recomendaciones del Dr. Marcus en
> este foro.
>
> Saludos,
>
> Andrés Ricardo Pérez Riera
>
> t _____________________________________
>
> > English - Spanish
> >
> > Dear colleagues,
> >
> > Before anything, I want to thank you for the organization and the
> > possibility of being able to participate in this forum about ARVD.
> > My specialty is not cardiology, but radiology, but I find myself in the
> > hard situation of facing my husband's death five months ago because of
> > this disease. It could not be diagnosed, though he had been through
> > several studies, including an electrophysiological study, which was
> > negative. I have three children of 11, 14, and 16 years old.
> >
> > I would like to ask you, what is the recommended age to make studies on
> > them? How frequently? And I also would like to know whether the
> > medication indicated for an attention deficit disorder with hyperactivity
> > (Methylphenidate) is counterindicated o it could have side effects. I
> > have seen on some of the comments I have been reading these days, that it
> > is necessary to include the partners as well in the screening. I also
> > wanted to confirm this opinion.
> >
> > Thank you very much.
> >
> > Sincerely,
> >
> > Dra. Isabel Escape
> > Barcelona
> >
> > Spain.
> >
> > ---------------------------
> >
> > Apreciados colegas.
> >
> > Ante todo queria agradecerles la organización y la posibilidad de poder
> > participar en este forum sobre ARVD.
> > Mi especialidad no es la cardiologia, sino la radiología,  pero me
> > encuentro ante la difícil situación de hacer frente a la muerte de mi
> > marido hace 5 meses a causa de esta enfermedad. No pudimos diagnosticarla
> > a pesar de haberle hecho numeros estudios, incluído un estudio
> > electrofisiólogico, que fue negativo.
> > Tengo tres hijos de 11, 14, y 16 años.
> >
> > Quisiera preguntarles a ¿que edad se recomienda  estudiarles? , ¿con que
> > frecuencia? y tambien saber si la medicacion que se administra para un
> > deficit de atencion con hiperactividad (Metilfenidato)  esta
> > contraindicada o puede tener efectos secundarios. En alguno de los
> > comentarios que he ido leyendo estos días tambien se comenta que es
> > necesario incluir en el screenig a los conyugues. Tambien querria
> > confirmar esa opinión.
> >
> > Muchas gracias
> >
> > Atentamente
> >
> > Dra. Isabel Escape
> > Barcelona
> >
> > Spain.