ADHD/ADD: The Cerebellum Deserves Attention

Brain function, as most easily seen in SPECT functional imaging, does help drive brain treatment options for ADD. One brain region often overlooked is the cerebellum.               

In ADD treatment and diagnosis so much attention has been directed to the prefrontal cortex many forget the importance of the cerebellum. Take a look at this illustration to see how far apart they are anatomically. The red in the front of the brain is the PFC [the prefrontal cortex], and the yellow down there in the back, posterior, is the cerebellum. [and note how far back the PFC covers]

They don't look like they are hooked up, but they are.

The functional brain literature from SPECT to qEEG, has focused on "cold spots" during concentration in the PFC. "Cold spots" have to do with lowered metabolism and diminished blood flow:

It has been known for over 100 years (Roy and Sherrington, 1890) that changes in blood flow and blood oxygenation in the brain (collectively known as hemodynamics) are closely linked to neural activity. When nerve cells are active they consume oxygen carried by hemoglobin in red blood cells from local capillaries. The local response to this oxygen utilisation is an increase in blood flow to regions of increased neural activity, occurring after a delay of approximately 1-5 seconds. This hemodynamic response rises to a peak over 4-5 seconds, before falling back to baseline (and typically undershooting slightly). This leads to local changes in the relative concentration of oxyhemoglobin and deoxyhemoglobin and changes in local cerebral blood volume in addition to this change in local cerebral blood flow. Wikipedia

All of this is to tell you something about how the functional imaging works, and what it measures.                                                                                                       
                                          

SPECT Example: SPECT measures rCBF [regional Cerebral Blood Flow]      

and looks like this with ADD: The PFC here has decreased rCBF: you can
see it at the top of this view->>

qEEG Example: qEEG [insiders call it a "Q"]
is an EEG with a computer readout of the brain surface activity, and looks like this: [from ADD Clinic] Look closely the second map over – shows a theta subset of ADD with a Q, and the clear PFC dysregulation.

An interesting article here in Pediatrics verifies improvement with NFB in slow wave cortical presentations [delta/theta].

So what does all this have to do with the cerebellum? More on page two.    

Well, we can also look at cerebellar function and see brain difficulties with SPECT imaging. The interesting take-home point: yes, brain areas that are not functioning well can be recognized through different tools, and, most importantly, attention to those under functioning areas can bring improvement.

I'll show you just one more brain shot before I close today, -as all this might be an overdose of

information. This SPECT scan will close the day with view of a hypo-function of the cerebellum. See how the red areas have a space between the right and left hemispheres? That "quiet area" that is the vermis of the cerebellum, and it shouldn't look like that. It's way to quiet and "cold." This is a problem.

This person very likely presents with ADD as a comorbid condition.

That's what all this stuff about hypo function is all about: the clinician can see it, and focus therapy on the impaired area and improve it. No matter how you slice it, this is good news for many people. The issue, as I regularly report, treatments for ADD are more effective if they address the appropriate comorbid issues.

RE: The Cerebellum-
All of the topics we have listed regarding non-med interventions for ADD have to do with helping the hypo-functioning [the under functioning] areas function more effectively. And, most importantly for this post: the PFC and the cerebellum are connected – and diminished function can be visualized and specifically addressed. The cerebellum is an interesting focus of some of those non-med interventions.

Take a look at this article in Neurology if you have additional interest in those PFC and cerebellar connections: a problem called frontal cerebellar diaschisis.

Stay tuned for the non-med treatments.