title: Acetyl-L-carnitine (ALC) in attention-deficit/hyperactivity disorder: a multi-site, placebo-controlled pilot trial.
abstract: OBJECTIVE
  To determine whether acetyl-L-carnitine (ALC), a metabolite necessary for energy metabolism and essential fatty acid anabolism, might help attention-deficit/hyperactivity disorder (ADHD). Trials in Down's syndrome, migraine, and Alzheimer's disease showed benefit for attention. A preliminary trial in ADHD using L-carnitine reported significant benefit.
  
  
  METHODS
  A multi-site 16-week pilot study randomized 112 children (83 boys, 29 girls) age 5-12 with systematically diagnosed ADHD to placebo or ALC in weight-based doses from 500 to 1500 mg b.i.d. The 2001 revisions of the Conners' parent and teacher scales (including DSM-IV ADHD symptoms) were administered at baseline, 8, 12, and 16 weeks. Analyses were ANOVA of change from baseline to 16 weeks with treatment, center, and treatment-by-center interaction as independent variables.
  
  
  RESULTS
  The primary intent-to-treat analysis, of 9 DSM-IV teacher-rated inattentive symptoms, was not significant. However, secondary analyses were interesting. There was significant (p = 0.02) moderation by subtype: superiority of ALC over placebo in the inattentive type, with an opposite tendency in combined type. There was also a geographic effect (p = 0.047). Side effects were negligible; electrocardiograms, lab work, and physical exam unremarkable.
  
  
  CONCLUSIONS
  ALC appears safe, but with no effect on the overall ADHD population (especially combined type). It deserves further exploration for possible benefit specifically in the inattentive type.
authors.affiliation: The Ohio State University Nisonger Center, Columbus, OH, USA.
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Arnold
authors.forename: Antonino
authors.initials: A
authors.lastname: Amato
authors.forename: Hernan
authors.initials: H
authors.lastname: Bozzolo
authors.forename: Jill
authors.initials: J
authors.lastname: Hollway
authors.forename: Amy
authors.initials: A
authors.lastname: Cook
authors.forename: Yaser
authors.initials: Y
authors.lastname: Ramadan
authors.forename: Lindsay
authors.initials: L
authors.lastname: Crowl
authors.forename: Dan
authors.initials: D
authors.lastname: Zhang
authors.forename: Susan
authors.initials: S
authors.lastname: Thompson
authors.forename: Giussepe
authors.initials: G
authors.lastname: Testa
authors.forename: Vernon
authors.initials: V
authors.lastname: Kliewer
authors.forename: Timothy
authors.initials: T
authors.lastname: Wigal
authors.forename: Keith
authors.initials: K
authors.lastname: McBurnett
authors.forename: Michael
authors.initials: M
authors.lastname: Manos
mesh_terms: D000108:Acetylcarnitine / Q000009:adverse effects / Q000627:therapeutic use*; D000704:Analysis of Variance; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005178:Faculty; D005260:Female; D006801:Humans; D008297:Male; D018697:Nootropic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D010290:Parents; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018697:Nootropic Agents; D000108:Acetylcarnitine