狠狠撸

神經精神?? 學第38 卷第5 號1999
J Korean Neuropsychiatr Ass.oc Vo138, No 5
????? ?????? ????
口? ?口
??? ??? ??? ??? ??? ???
???* . ???* . ???* . ??? *t . ???* . ???* . ???*
Cerebral Functional Localization Related to Attentional Work in
Patients with Attention-Deficit Hyperactivity Disorder
Dong Won Shin, M.D. ,* Dong Ho Song, M.D. ,* Duk-In Jon, M.D. ,*
Kee Namkoong, M.D. ,*t Man Hong Lee, M.D.,*
Hong-Shick Lee, M.D. ,* Sung Kil Min, M.D.*
????:
????? ??????? ???? ??? ?? ????. ???? ?? ???? ??? ???
? ??? g?? ?? ???? ????? ?????? ??? ???? ???? ??? ??? ?
??? ???， ??? ?????? ???? ??? ?????. ?? ? ??? ????? ????
?? ??? ??? ??? ??? ???? ?? ????? ?? ??? ??? ??? ???? ??
??， ??? ??? ?? ????? ???? ??? ????? ?????? ??? ??? ???
??? ?? ??? ??? ???? ???. ?? ????? ??????? ???? methyl?phenidate?
????? ?????? ???? ???? ??? ?? ?? ????? ? ??? ?
?? ????， ???? ???? ??? ??? ?? ??? ???? ???
? ?:
?? ???? ?? 201?， ??? 20??? ? 40????. ? ?? ??， ??. ???， ??? ??
? ??? ??? ?????. ???? ?? ??? ??? ??? ???? ?? ??? ??? ??
???. ???? methylphenidate? ??? ??? ???? ?? ???? ?? ?? ??? ???
??? ???? ?? ??? ??? ?????.
? ?:
? ??? ??? ??? ??.
1) ??? ???， ?????? ?? ? ???? ?? ????? ?? ??? ??? ?? ???
?? ??? ??? ????? ?? ???? ?? ??? ?? ???? ??? ? ? ???. ???
???? : 1999? 2? 5 ?
???? : 1999? 4? 7 ?
*????? ???? ??????
Department o[ Psychiatry, Yonsei University College o[ Medicine, Seoul
t Corresponding author
- 1089 -

? ?? ??， ?? ??? ?? ?? ??? ??， ????? ?? ?? ?? ?? ?? ?? ????
?? ??? ??， ?? ? ???? ???? ???? ?????. ?? ???? ?? ? ??? ??
? ??? ??? ??? ???.
2) ?????? ?? ??? ??? ?? ? ???? ???? ???? ?? ???? ??? ??
???? ???.
3) ??? ??? delta ? ???? ??? ??? ??， ?? ???? ??， ??? ?? ??? ?
???? ??? ?? ??? ??? ??? ???? ??????， ?????? ??? ?? ??
???? ??? ???? ??? ??， ???? ? ?? ??? ??? ? ???.
4) Theta ? ????， ?? ???? ??， ??? ?? ??? ????? ?? ?? ???， ??
???， ?? ?? )??? ???? ??? ???? ????? ??? ????? ???? ???
???? ???? ??? ???. ????? ?? ??? ?? ???， ?? ???， ?? ?? →??
? ???? ???? ??? ???， ?? ???? ??? ????? ?? ??? ???.
5) Alpha ? ????， ?? ???? ??， ??? ?? ??? ????? ??? ?? -??? ?
??? ???? ??? ???? ??， ???? ?? ???? ?? ???? ???? ???? ??
? ???? ? ?? ?? ??? ????? ???.
6) Beta ? ????， ?? ???? ?? ????? ?? ??? ?? ??? ?? ???? Cz ?
??? ???? ??? ???? ??， ?? ?? ?? ???? ?? ?? ?? ????? ??? ?
??? ??? ?? ?? ?? ??? ????? ???. ??? ??? ?? ???? ?? ????
??? ???? ??? ???? ? ?? ?? ??? ???，
? ?:
????? ?????? ??? ?????? ???? ??? ??? ?????? ????? ?
?. ???? ??， ?? ??? ??? ??? ?? ??? ?? ???? ?? →???? ?????
?? ????? ?????? ??? ???? ????? ?????. ????? ?????? ??
? ??? ??? ???? ?? ??? ??? ??? ??? ?? ??? ????.
?? ?? : ????? ?????? · ??? ?? · ??? ?? · ??? ?? · ??? · ?? ???.
? ?
????? ?????? ??? ????? ???
? ??? ??? ???? ?? ??? ?? ? ??
??? ???， ?? ?? ?? ???? ???? ?
??. ?? ???? ?? ???? ???? ???
??? ??? ??1) ????? ??????? ??
??? ??? ??? ???? ?? ???? ???
??? ??? ??? ????? ?? ??? ???
? ? ? ???? ???? 2)
????? ?? ???? ???? ????， ??
? ??? ?? ???? (pulvinar nudeus). ???
?? (colliculus) ???.? ??? ??? ??? ??
?? ???? ???? ?????， ??? ??? ?
??? ????? ???? ??? ?? 3) ?????
?????? ??? ???? ???? ?? ???
???? ??? Test of Variables of Attention(?
? T.O.V .A.)? ???? ??? ???? ?? ??
? ?????， ????? ??? ??? ???? ?
?? ??? ?????， ????? ?????? ?
?? ?? ??? ?? T.O.V .A.?? ??? ?? ??
???? ??? ? ???? ????? 4) ?????
???????? ????? ??? ??? ???
?????????.
?? ??? ??????? ??? ?? catechola?mine???
??? ??? ?? ??? ???? ?
? 5) Norepinephrine ????? ????， ???，
??? ?? ??? ?? ???? ?????， ???
???? ?? ?? ??? ??? ????? norep-
1090 -

inephrine? ???? ?? ?? ??? ??? ??
? ??? ? ??. ???? ?? ??Oocus ceru?leus)
? ????? ?? ?? ???? ???? ?
?. ??? ?? ????? ?????? ????
norepinephrine? ??? ???? ????? ??
????? norepinephrine ??? ??? ????
??. ????? ????? ??? ??? ??? ?
? ?? ?? (ventral tegmental area)? ?????
? ????? ??? ??? ???? ??. ????
????? ?? ??? ??? ???? ???? ?
?? ???? ?? ?? (working memory) ? ??
?? ??? ?? ????????. ??? ????
? ????? ??? ??? ???? ?? ????
????? ?? ?? ?? ??? ?? ??? ?? 6)
??? ????? ?????? ??? ?????
??? ?????? ??， ??????? ??? no?repinephrine
?? ??? ?? ???? ???? ?
???? ????? ??? ????， ?? ?? ??
??? ??? ??? ???? ???? ?? ???
????? ??? ????? ??? ? ???? ?
?? ????? ?? 5) ??? ???? ??? ??
??????? ?? ?????????????
? ?? ??? ???? ??? ?????? ???
? ??? ? ???? ???? ??? ??? ? ?
? ??? ????. ??? ????? ??????
??? ????? ???? ??? ??? ????
?? ??? ?? ???? (positron emission tomo?graphy,
?? PET)? ??? ??， ??? ?? ??
? ??? ???? ??， ?? ??? ?? (premot?or
cortex) ? ????? ?? (superior prefrontal
cortex) ?? ???? ?? ? ??? ???? ???
????， ? ??? ??? ????? ??????
? ??? ?? ??? ????? 7) ?? ?? ???
?? ??? ???? (single photon emission com?puted
tomography, ?? SPECT) ???? ?? ?
?? ?????? ??? ?? ??? ?? ?? ??
?? ?? ???? ?? ???? ? ??? ??? ?
?? ? ?? 8) ??? ? ??? ????? SPECT
???? ??? ??? ?? ??? ??? ??? ?
??? ?? ??? ?? ??? ???， ??? ??
?? ?? ????? ?? ??? ???? ?? ??
?? ??? ???? ???.
Clark ?? norepinephrine? ?? ??????
????? ??? ??? ????? ??? 9) ???
? ???? ???? ?? ??? ????? ???
??? ???? ???? ?????ll) ?????
??????? ???? ???? ???? ????
??? epinephrine? ?????， ??? ?????
???????? ??? ??? ??? ?? ???
???? ?， ???? ???? ??? epinephrine
?? ????? epinephrine? ???? ?????
? epinephrine? ???? ?????， ? ?? ??
? ?? ???? ???? ???? ??? ????
? 12) ??? ???? ?????? ???? norep?inephrine
??? ???? ??? ???? ????
???? ??? ? ??? ??? ???? norep?inephrine?
?? ????， ???? ?? ??? ?
??? ??? ?? ???? ??? ????? ??
? ?? ??? ????. ??? ???? ????
??? ? ??? ??? ????? ??? ????
? ??? ???? ???? ???? ??? ?? ?
??? ???? ??? ???? ???? ????
???????.
??? ?? ??(quantitative electroencephalo?graphy)
? ???????(magnetic resonance im?aging,
MRI), SPECT, PET? ?? ?? ?????
?? ???? ?????? ???? ??????
??? ??? ???? ??? ? ??? ?????
?? ??? ??? ??? ??? ????. ?? ?
?? (millisecond) ??? ?? ??? ??? ???
? ??? ? ? ????，?) ??? ?? ?? ?? ?
??? ???? ????? ???? ??? ? ??.
????? ?????? ??? ???? ???
??? ?? ?? ?? ?? ????? ??????
??? ?? ??? ?? P3, Oz, P4?' ? alpha9.J- be?ta?
??? ??? ???? ??? ??? ?? 14)
beta? ??? ???? ??? ??? ??? ???
?? ?? ??? ??? ??? ??? ?? ????
?? ??? ????? ??? ??? ??? ???
???? ?? ???? ???? ??? ??? ??
? ? ?? ??. ??? ??? ??? ???? ??
??? ??? ??? ?? ??? ???? ??? ?
1091

??? ?? ?? ?? ??? ????.
??? ??? ??， ?? ???? ??? ???
??? ?? ??? ????? ??? ???? ??
?? ????? ?? ????， ????? ????
?? ??? ??? ??? ?? ??? ??? ???
?. ??， ????? ??????? ???? meth?ylphenidate?
??? ??? ??? ??? ???
????? ?? ??? ??? ?? ???? ???
? ?????? ????.
?? ? ??
1. ?? ??
?? ???? ????? ??? ??. ???， ?
?? ??? ??????， ?? ????? ????
??? ???? ???? 3~9? ?? ? ?? ???
? ??? ?? ??? ??? ? ?? ???? ??
??? ?? ??? ?? ???? lG) ???， ???
5~13? ??? ???? ???. DSM-N ? ?? ?
?? ???? ????? ??????? ??? ?
??? 161 ???， ??? Conners ?????? ??
?? 15? ??? ???? ?? ???. ??? Co?nners
????? ??? ???? , ????， ???
? ??? ??? ?? 1Q7H ? ???? ???? ??
? ??? ?? 0?? 30???? ??? ????， ?
??????????， ????， ???? ????
??? ? ??? 15? ???? ????? ????
?? ??? ??? ???? ????? ???? ?
?? ?? 17) ????. KEDI-WISC(Korean Edu?cational
Development Institute-Wechsler Intellig?ence
Scale for Chi1dren)? ??? ????? 75 ?
?? ???? ????， ?????? ??， ???
?， ???? ??? ??? ????.
?? ????? @ ????? ??(??， ???
???? ??)? ?? ? ???? ????@??
??? ?? ??@?? ???? ??(????， ?
???， ??? ?)? ??? ?? @ ??? ??? ?
???? ??? ??(?， ?? ??? ??) ???.
???? ?????? ??? ???? ??? ?
??? ??? ??? ???? ?? ???? ???
??? ??????‘ ???? ??， ??， ????
??? ??? ??? ???.
???? ???? ?? ?? ?? ?? 20????
? ?? ??? ??? ???? ???? ? ???
???? ??? ??? ?? ???? ?? ??? ?
???????.
2. ????? ???? :T.O.V.A.
T.O.V.A.? ???? ???? ?? ??? ???
??? ??????. T.O.V.A. ?? ?? ??? ?
?? ???? ??? ?? ??? ? ?? 2?? ??
???? ???? ??. ??? ?? ?????? ?
?? ?? ?? ????? ????? ?? (target)
??? ??? ?? ????? ??? ?? ????
? ????， ??? (nontarget) ??? ???? ?
??? ???? ????? ??? ???? ???
? ???? ???? ???? ?? ???.
T.O.V.A ??? ?? ??， ??? ??， ????
? ?? ?? ??? ??， ????? ?? ??? ?
?? ????， ????， ?? ??， ??? ?? ?
?? ??? ??? ??? ????? ???? ??
? ???? ??? ?? ????? ???， ????
? ????? ??? ????.
3. ?????
????? ?????? ???? 1??? ???
??????? ?? ? ????? ??? ?? ??
?? ??? ??? ?????. ??? ???? ??
???? 1??? ??? ?? ??? ??? ?? ?
? ?????? ?? ???? ?????????
?? ??? methylphenidate? ??? 1kg? 0.7
mg? ?? ?????. Methylphenidate? ???
? 20?? ???? ????? ????? ????
??? ??? ????? 1??? ??? ?? ???
? ??? 18)19) ?? ??? ? ????? methylph?enidate?
???? 1??? ??? ??? ?? ??
???? ?? ???? ???????????.
?? ???? ????? ??? ?? ???? ?
?? ??? ?????‘
?? ???? ???? ????? ?? ? ?? ?
??? ???? ?? 2?? ??? ??? 32? ??
1092 -

? ??? ??(ElectroCap?. 1994? ??. Eaton.
Ohio. USA)? ??? ?????. ?? ??? ??
?? 1O ~20 ?? (international 1O~20 system)?
???. ??? impedence? lOk.Q ??? ???. ?
? ???? 10? ?? ?????? ????? ?「?
?? ? ??， ??? ?? ??? ?? ??????
??? ??????， ??? ???? ?? ??? ?
?? ?????， ? ?????? ??? ?????.
???? ???? ???? ??? ??? Neu?ronics(
?? ??????. 1995? ??， ??)? ??
???? , ??? ??? ??? Lee ?? ??? ??
? ?? ???? ???? ????? 20) ??? 1?
? ? ?? (epoch) ? ?? ??? ???? ???
256?? ???. ? ?? ??? ???(neural net?work)
? ?? ?? ??? artifact? ??? ?? ?
??? ?? ???? (artifact) ? ??? ?????
????? ??? ???? ? 20~50? ??? ??
? ????? ?????. ??? ?? ??? ???
? fast Fourie tran8formation (FFT) ?? ????
??? ???. ??? ????? delta 1 ~4Hz. th
eta 4~8Hz. alpha 8~ 13Hz. beta 13~22Hz? ??
???， ??? ??? ?? ??? ??? ?? 30?
?? ??? ??? ? ? ? ? ? ? ??(brain map)
? ??????. ? ??? 30? ??? ???(??
? J1V)? ????? ??? 211
4. ????
@ ?? ???? ???? ??? ?? ?? ???
t-te8t? ??? ?????， ?? ?， ?? ????
?? ? ?? ?? ??? paired t-te8t? ??? ??
?????.
@ ?? ???? ???? ??? ?? ???? ?
?? ????? ?? ?? ?? t-test? ??? ??
??? ?? ?? ? ???? ???? ?? ??
paired t-te8t? ??? ?????.
@ ?? ???? ?? ?. ?? ????? ????
?? ???? ??? ?? ???? ??? ????
? ??? ??? ??? ?? ????? ???? ?
?? ?? ??? paired t-188t? ??? ?????.
??? ?? ????? Statistical Analysis Sy-
Table 1. Neuropsycological tests-intelligence
Variables Controls Patients
Total IQ 107.8S :t1O.46 100.33 :t 17.32
Performance IQ 109.70:t l 1.96 101.00:t 18.43
Verbal IQ 106.2S :t l0.97 102.08 :t 17.31
IQ : intelligence quotient
NS : not significant in t-test
P-value
NS
NS
NS
stem(SAS)? ??????， ??? ????? 0.05
??? ?? ??( two-tailed)? ???.
? ?
1. ???? ??
????? ????? ??? ?? ???? ??
??? ?????? ?? 201? , ?? ?? 20???
? 40????. ?? ?????? ? ?? ????
?? ??? ????? ?????? ??? ???
?? ?? 9 .40 :t1. 93.8.65 :t1.???， ??? ???
???(p>0.05 )，
2. ?????? ? ^t
1) 7':1 ??? (KEDI-WISC)
?? ???? ???? ??? ?? ?? ??? ?
???? ??? ??? ???(p>0.05)(? 1).
2) ??? ?^t(T. O. V.A.)
?? ???? ?? ?? ???? ??? ?? ??
? t-18st? ???? ?， ?? ??? ??? ???
????? ??? ????， ????? ?? ???
??? ?? ??? ?? ??? ??? ????? ?
? ???? ????? ???? ???， ?????
? ???? ? ??? ?????(p<O.01. p<0.005)
(? 2).
????? ?? ?? ?? ??? paired t-te8t?
??? ????? ?， ?? ??， ?? ??? ?? ?
? ??? ??， ????? ?? ?? ? ???? ?
?? ???? ?????， ?? ?? ???? ???
? ?????(p<O.0 1. p<O.01. p<0.05) ?? ?
???? ?? ??? ???? ??? ??? ???
(p>0.05)(? 2).
1093 -

Table 2. Neuropsycological test-attention
Variables Controls
Omission error 57.37 :t 16.61
Commission error 51.57 :t 19.94
Response time 54.32 + 12.41
Variability 53.01 :t 1 0.58
'T-test between controls and patients before medication
'Paired t-test between patients before and after medication
? : p<0.05, ?? : p<O.Ol
3. ?????
1 ) ?? ???? ????? ?????? ??? ^t
??| ????? ?? ??? ??
(1) Delta ?
?????? ??? ???? ?? ???? ??
? ?? ?? ??? ??? ?? ??? ???， ??
{??? (F3 ， F8. FTC1. T3. C3, CZ. C4. T4, Tcp1‘
Cp2, Pz, Pol. Po2. 0 1. 02) ????? ?? ? ?
??? ?? ????? ???? ?? ?? ????
?(p<0.05). ???? ??(Fp2? ??? 29?? ?
?) ???? ?? ? ??? ??? ?? ?? ???
???? ??? ??? ?? ??? ?? ?? ??
???? ??(Fp2? ??? ??? 29? ??) ??
?? ??? ???? ?? ??????， ?? T6.01
????? ???? ???? ?? ?????(p<O.
05)(?? 1). ??? ?? ??? ?? ??? ???
???? ?? ???? ???? ??? ???
(2) Theta ?
???? ?? (F7. Cpl. T5. Pz. P4? ??? 25?
??) ???? ?? ???? ??? ?? ?? ??
? ???. ?? ? ???? FTC1? ??? 29??
?? ???? ?? ? ???? ?? ?? ??? ?
? ?? ? ????? ?? ?? ??? ???? ?
?? ?????(?? 2) .
(3) Alpha ?
?? ???? ??? ?? ?， ?? ???? ???
? ??? ?? ????? ???? ???(p<0.05)
(?? 3) .
Patients
Before medication After medication
59.34:t 1 0.30 53.14:t 7.74' ??
45.17 :t 9.37 48.63 :t 1 0.57
66.20 :t 14.12’ ?? 58.68:t 13.40'*'
65.68:t 15.34' ?? 57.53 :t 14.00'.
(4) Beta ?
?? ???? ?? ?， ? ???? ???? ??
??? ???? ??? ???(p<0.05). ?? ??
? ??? ???? ??? ??? ???? ???
(p>0.05)(?? 4).
2) ?? ???? ????? ?????? ??? ?
。|?l ??? ?? ??? ??
?? ???? ?? ?， ?? ????? ?????
? ????? ????? ??? ?? ?? ??? ?
?? ???? ??? ?? ??? ???.
(1) Delta ?
?? ???? ?? ??? ???? ??? ???
?? ??? ?? ???? ??(Fp 1. F7. F8? ??
? 27? ??) ???? ??? ???? ??? ??
??， ??， ?? -??? (Cp 1. Pol. Po2. 01. Oz ?
?) ????? ????? ???? ??? ????
?(p<0.05). ?? ?? ?? ? ??? ??. FTC1?
??? 29? ?? ???? ??? ???? ??? ?
???? ?? ? ???? ??， ???? ??(Fp l，
Fp2. F7? ??? 27? ??) ???? ??? ???
??? ???? ??? ?? ?? ???? ??? ?
?? ?????(?? 1).
(2) Theta ?
?? ???? ????? ?? ?? ???? ??
?? ?? ?? ??? ????? ??? ?? ???
F7? ??? ??? ?? ?? ???? ??? ??
????， ???， ??? ??， ??→???? 18?
?? (F4. F8. FTCl. Cz. T4. TTl, Cp1. Cp2. Tcp2.
TT2. Pz. P4. T6. Po1. Po2. 01. Oz. 02) ????
1094 -

Controls
Patients:
before
medication
Patients:
after
medication
at rest at attentional
work
體10 ? 醒0， 05
? v
3 JtV ?1.00
?10 ? 醒0， 05
? v
3 JtV ?1.00
?10 ? ?0， 05
? v
3JA .. V ?1.00
voltage SPM p-value
Fig. 1. Topographic distribution of absolute amplitude of delta power in controls and patients at rest and attentional work,
Controls
Patients:
before
medication
Patients:
after
medication
at rest at attentional
work
? 13 ?
? V
3 JtV
? 13 ?
i v
3 JtV
? 1 3JtV
? v
3 JtV
voltage
?0， 05
?1.00
?0， 05
?1.00
?0. 05
SPM p-value
Fig. 2. Topographic distribution of absolute amplitude of theta power in ?onttols and patients at rest and attentional work‘
????? ???? ??? ?????(p<0.05). ?
? ?? ?? ? ?????? ????? ?? ???
?? ?? ???? ???? ?? ??? ??， ??
? ???? ????? ??? ???? ???(p)
0.05) ?? ? ?????? ???? ??(Fp1. Fp
2. F7? ??? 27? ??) ???? ??? ????，
??， ???‘ ???， ?? ←???? 15? ?? (Fz ，
F4. T4, Cpl, Cp2, Tcp2 TT2, T5, Pz, P4, T6, Po2
01, Oz, 02) ???? ????? ???? ???
??? ?? ???? ??? ??? ???(p<O ， 05)
(?? 2) ,
? 1095

Controls
Patients:
before
medication
Patients:
after
medication
at rest at aUentional
work
? 21 ?
j ?
3 JtV
? 21 ? ? 0.05
? v
3 JtV
? 21 ? ? O ?
? v
3 JtV
voltage SPM p-value
Fig. 3. Topographic distribution of absolute amplitude of alpha power in controls and patients at rest and attentional work.
Controls
Patients:
before
medication
Patients:
after
medication
at rest at aUentional
work
?10 JtV
I::~ 3 JtV
?10 JtV
? 3 JtV
?10 ?
? 3 JtV
voltage
? 0.05
?1.0。
? 0.05
?1.00
? 0.05
?1.00
SPM p-value
Fig. 4. Topographic distribution of absolute amplitude of beta power in controls and patients at rest and attentional work.
(3) Alpha ?
?? ?????? ????? ?? ??? ?? ?
? ?? ??? ?? (Po 1. Po2. 01. Oz. 02) ? ??
? ???? ??? ?? (p<0.05). ?? ?? ???
?? ?????? ?????? 20?? ?? ???
???? ??? ???? ?? ???? ???? ?
?? ??? ????? ? ????? ??? ???
?? (p<0.05L ?? ? ???? ?? ??-??? ?
? (Cpl. Pol. Po2. 01. Oz. 02) ?? ???? ??
? ??? ?? ???? ??? ???? ???? ?
? ?????'(p<0.05)(?? 3).
? 1096

(4) Beta ?
?? ???? ?? ??? ??? ??? FTC1.
Cz ????? ????， ?? ? ????? ???
??? ?????? T4? ??? 29? ??????
???? ??? ??? ????? ??? ?? ??
? ?????(p<O.05). ?? ? ???? ??， Fp1.
F7, F3, Fz, FTC1, TT1 ， TT2? ??? ???? ??
? ??? ???? ??? ?? ???? ???? ?
??? ?? ?? ??? ?????(p<O.05) (?? 4).
? ?
????? ??????? ????? ???? ?
????， ? ?? ??? ?? ???? ??? ??
??. ????? ????? ??????? ?? ?
??? ?? ???， ?? ????? ? ??? ??
? ??? ?? ??? ??? ???? ??? ???
???)?) ??? ????? ??????? ??， ?
?， ??????? ????? ???? ??? ??
??? ??? ?? 241251261 ????? ???????
?? ????? ???? ????? ???? ??
? ??? ?? ??? ?? ???? ??? ? ??
?.?)?) ?? ???? ??? ??????? ???
??， ??? ??? ??????? ??? ??? ?
??? ???? 291?3 Jl ??? ??????? ???
??? ?? ??? ?????? ??? ? ??. ?
?? ? ????? DSM-N ????? ?? ???
?? ??? ??? ?? ????? ?????? ?
?? ?????? ?????.
T.O .v.A.? ‘???? ??? ?? (Minnesota Co?mputer
Assessment ?? MCA)? ??? ????
? ??? ?? ??? ??? ??? ????? ??
? ?? ??? ??? ??????(Visual Continu?ous
Performance Test : CPT)??. ???? ???
?. ????? 1994??? ??? ??? ????， ?
???? ?????? ??? ??? ??? ???
????? ??????? 1? ????? ??? ?
?? ????? 41 ? ???? ???? ??? ?， ?
??? ???? ???， ????? ???? ???，
????? ?????? ??? ?? ???????
?? ?? ??? ?，?} ??? T.O.V.A.? ??? ??
? ????? ??? ?? ??， ??? ??? ???
?? ????? ????.
??? ?? ??， methylphenidate? ???? ?
? ???? ???? ?? ???? ????? ??
????? ???， methylphenidate? ???? ?
??? ????? ????? ????? ?? ??
?? ??? ???. ?? ????? ????? me?thylphenidate?
??? ??? ???? ?? ??
???? ????. ?? ???? ???? ????
???? ?? ??? ????? ?????? ??
?? ???? ????? ???? ?? IOl1Jl ? ??
?? methylphenidate? ???? ??? ??? ?
?? ??????? , ??? 1kg? 7mg? ??? ?
? ?? ????? ????， ????? ?????
?????????.
? ???? ??? ??ι? ?? ???? ? ? ?
?? ?? ???? ?? ???? ?????? ??
?? ??? ???. ?? ?? ???? ??? ??
???? ??? ???? ?? ??? ?? ????
????? ???? ???. ? ??? ???? ??
??? ??. Satterfield ?? ?? ? ???? 7.5?
?? ????? ?????? ??? ??? ?? ?
??? ?? ?? ??? ??? ??? ??? ???
??? Mann ?? ?????? ????? ???
??? ??? ?????? ?? ???? ?? ? ?
?? ?????? ????????， ??????
???? ?? ?? ? ???? ????? ????
?.341 Janzen ?? ????? ?????? ????
?????? ?? ??， ?? theta ?? ???? ?
???? ????? 351 ?? ?? ??? PET? ??
??? ???? ??? ???? ??? ?? ???
??? ??.361 Zametkin ?? PET? ???? ??
??? ?????? ??? ? ??? ??? ?? ?
??? ?? ????? ?????， ?? ?????
?????? ??? ?? ??? ??? ??? ??
? ? ??? ????? 71 ? ???? ????? ?
????? ??? ?? ???? ?? ???? ??
???? ?? ??? ????， ????? ????
?? ??? ?? ??? ?? ???? ?? ????
?? ??? ? ?? ???. ??? ????? ??
???? ??? ?? ?????? norepinephrine
- 1097 -

? ???? ???? ??? ??? ?? ??? 5112)
???， ?????? norepinephrine? ?????
????? ???? ??? ??? ???? ???
??? ?? ??. ????? ?????? ??? ?
????? ?? ?????? ?????? ?? ?
? ??? ???? ??? ???? ????， ??
? ??? ??? ??????????????.
Delta ? ???? ?? ???? ??， ??? ??
?? ?? -??? ??? ????? ????? ?
?? ???. ?? ?? ????? ??? ????
??-???? ???? ???? ?? ??? ??
? ???? ??? ??? ??? ?? ?? ???
?? ?????? ??? ???? ??? ?? ??
????? ???? ?? ???? ?? ?????
??? ????， ??? ?? ????? ???? ?
? ???? ??? ???? ?? ?????， ??
???? ???? ?? ??? ???? ???. ??
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???? ?????? ???? ???? ?????
??? ??? ?? ??? ????? ??? ?? ?
??????
? ???? ?? ???? ?? ??? ?????
????? ?? ?? ? ????? theta ?? ??
?? ???? ????. ????? ?-???? ?
?? ??? ????? ??????? ?????
??? theta ? ???? ????? ?? ??? ?
??? ???? 37)? ??? ????? ??????
????? theta ? ???? ??? ??? ???.
Mann ?? ????? ?????? ???? ??，
??? ?? ???? ??? ??? ??? ????
??， ??? ??? ??? ???? ??? ????
theta ? ???? ????? ?????.?) ???
????? ??? ??? ???? ??? ?? ??
? ??. ? ????? ???? ???? ??? ?
?? ?? ???? ??? ??? ??? ?????
?? ? ?? ??? ??? ??? ?? Mann? ?
? ??? ?? ??? ?? ???? ???? ??
? ? ???? ????? ?????? ??? the?ta
? ??? ??? ?? ?? ?????? ???
??? ?? ???? ???? ???.
?? ???? ?? ??? ?? ?? alpha ? ??
?? ??-??? ???? ????? ???? ?
?? ????. ? ???? ??? T.O .v.A? ???
?? ?????? ???? ?????? ????
?? ?? -???? ???? ??? ?? ?? ??
??? ??? ??? ?? 3) ??? ?? ?????
??? ???? ??-???? ???? ????
?? ?????? ???? ?????????. ?
??? ????? ?? ? ??? alpha ? ????
?????， ?. ??? ??? ?? ?? ??? ? ?
? alpha ? ???? ???? ??? ??? ?? 39)
??? ? ???? ????? ?????? ???
??? ??? ???? ?? ??? ?? ?????
???? alpha ? ???? ???? ?? ????
?. ??? ?? ?????? ??? alpha? ??
(attenuation)? ??? ?? ?? ??? 40) ???，
??? ??? alpha ?? ???? ???? ???
???? ???????
?? ???? ??， ??? ??? beta ?? ??
?? ???? ???? ??? ?? ?? ?????
?????? ??? ??? ??? beta ?? ???
? ?? ???? ?? ???? ?????. ????
?? ??? ?? ?? (restless behaviour) ? beta
? ???? ??? ??? ??? ?? 4]) ?? (nucl
eus accumbens) ? ??? ???? ???? ???
? ????? ??? 42) ???， ????? ????
??? ??? ?? ??? ??? ??? ?????
????? ?? ??? ?????， ?? ?? ???
? ???? ?? ?? ?? ??? ??? ??? ?
???.
????
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ABSTRACT J Korean Neuropsychiatr Assoc Vol ?:， No 5, September, 1999
Cerebral Functi.onal Loca1izati.on Related t.o Attenti.onal W.ork in
Patients with Attenti.on-Deficit Hyperactivity Dis.order
Dong Won Shin, M.D., Dong Ho Song, M.D., Duk-In Jon, M.D.,
Kee Namkoong, M.D., Man Hong Lee, M.D.,
Hong-Shick Lee, M.D., Sung Kil ?n ， M.D.
Department of Psychiatry, College of Medicine, Yonsei University, Seoul
Objectives : The attentional dεficit is a core symptom in attention deficit hypεractivity
disorder. The m? or brain arζas rζlated to attεntion are frontal and pariεtallobes. Abnormalitiεs
of frontal and parietal lobes in attention dζficit hyperactivity disorder have bζen reportεd in
prεvious rεsεarches. But, most of thε rεsζarchεs arε basζd on comparing patiζnts and controls
while they arζ in resting condition. Furthζr resζarch on funtional changζs rεlatζ， d to Pζr?formance
of attlεntional task is needed to understand the attentional dysfuntion in attζntion
? 1100 -

deficit hyperactivity disorder. In this study, thε localized functional. changes of the brains
related to attentional task in pa?ents with attention deficit. hyperactivity disorder and thζ
differences of them bεtw?n patients and normal controls wεrε εxaminεd. Also the ζffect of thε
methylphenidate on functional changζs rεlated to attentional task in pa?ents with attention
deficit hyperactivity disordεrwas examinεd.
Method : Quantitative electroεncephalography(QEEG) was app1ied to examine thε fuctional
changes related to attentional task. Subjεcts of this study consiste<,i of 20 pa?ents with attεntion
deficit hypεracti'?ty disorder and 20 controls who wεre matchζd agζ， sex， handεφ1ζss， intε?gζnce.
QEEG was rεcorded on εyζ opεn rζ， S?19 condition, and on pεrforming computζrized atrentional
task. In casζs ofpatiεnts， afi:er ta?ng of methylphenidat'ε， QEEG was recordεd on both conditions.
Results :
1) In attention tεst， normal controls had better scorεs in response time and variabilities of
responsε ?mζ than those of patients with attention deficit hyperactivity disordεr without taking
methylphenidate. After taking medication, scores of omission, response timeand variabilitiεs of
response time were significantly improvεd， comparing to scorεs without taking mεdication. No
differencεswεrε rζcognized betw?n the controls and pa?ents with taking mεdication in scorεs
ofattζntion test.
2) In resting condition, spectral EEG revealed baseline activity levels of pa?εnts werε
significantly incrεasεd comparing to those of controls.
3) Analysis of delta wave revealed that amplitudes of controls were significantly elevated in
pariεto-occipital arεa during performance of attentional task. But in patiεnts， localizεd activatεd
area rε， latεd to attentional task was not remarkable.
4) Theta activity of controls were significantly εlεvatεd in right frontal, right tζ， mporal， and
both parieto-occipital areas during performance of attentiona1 task. But in patiεnts without
taking medication, localizεd activated area relatζd to attζntional work was not remarkable. Aftεr
taking medication, right frontal, right temporal, and both parieto-occipital areas were signifi?cantly
activated.
5) Alpha activities of controls were significantly incrεased in parieto-occipita1 area during
performance of attentional task, but those of patients without taking mεdication werε mcrε， ased
in broad area.
6) Beta activities of controls were signific
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