Attention Deficit/Hyperactivity Disorder (ADHD)
Novel and Emerging Strategies
Monitoring Brain Waves to Aid ADHD Diagnosis
In July of 2013, the FDA approved the use of a new brain-wave-monitoring system to assist physicians in diagnosing ADHD in children and adolescents aged 6 to 17. The system is called the Neuropsychiatric EEG-Based Assessment Aid (NEBA). The non-invasive test takes about 15 to 20 minutes and involves placement of sensors on the scalp of the individual to monitor their brainwaves. Individuals with ADHD typically have a significantly higher theta/beta brainwave ratio, and the NEBA system can identify this phenomenon (Brauser 2013; FDA 2013).
However, not all physicians agree on the value of this new test. Some feel it could add value and improve ADHD diagnosis accuracy and possibly reduce unnecessary referrals, but others believe that current standards for ADHD diagnosis are sufficient. More evidence is needed before the value of the NEBA system can be stated unequivocally (Brauser 2013).
Dasotraline, a novel compound being investigated for use in patients with ADHD, is believed to strongly inhibit the reuptake of both dopamine and norepinephrine, as well as weakly inhibit serotonin reuptake. Dasotraline is distinguished from stimulants used to treat ADHD by its slow absorption and long elimination time. Dasotraline is meant to be taken once per day and a steady blood concentration is achieved after 10‒14 days of daily use. These characteristics suggest dasotraline may have a sustained effect over 24 hours and likely has a low risk of being abused as a stimulant (Koblan 2015; Hopkins 2016; Sunovion 2014).
In a randomized controlled trial, 341 adults with ADHD received either 4 mg or 8 mg of dasotraline or placebo daily for four weeks. Those in the 8 mg group had significant improvement in an ADHD rating scale compared with placebo, while a trend towards improvement was observed in the 4 mg group. Mild-to-moderate side effects were frequent with both doses, with a greater prevalence in the high-dose group. The most common side effects were insomnia, decreased appetite, dry mouth, anxiety, and nausea. The most common severe side effects were insomnia, anxiety, and panic attack, all of which were more common in the higher dosage group. In a randomized controlled trial of 48 individuals who had used cocaine and other recreational stimulants, dasotraline showed a low potential for abuse compared with methylphenidate (Koblan 2016; Sunovion 2014).