Benjamin Kay

Ritalin Works-But Not the Way We Thought - Common Reader ADHD, sleep deprivation, amphetamines and the truth of why they work

@jcooperman.bsky.social proves essay writing is *not* a lost art in her engaging, in-depth write-up of our latest research on stimulant drugs. I highly recommend her journalism, and you can find the science published in the journal Cell.
commonreader.wustl.edu/adhd-and-rit...
doi.org/10.1016/j.ce...

Parkinson’s disease as a somato-cognitive action network disorder - Nature The substantia nigra and all Parkinson’s disease deep-brain stimulation targets are selectively connected to the somato-cognitive action network rather than to effector-specific motor regions.

More excellent reporting by NPR's Jon Hamilton about a new brain network that explains symptoms of Parkinson's that have befuddled brain researchers for decades. Kudos to @jianxunren.bsky.social and Hesheng Liu for this groundbreaking research in the journal Nature! doi.org/10.1038/s415...

Brain network responsible for Parkinson’s disease identified A brain network first identified by Washington University in St. Louis School of Medicine researchers, called SCAN, is shown in a new study to be the neurological basis for Parkinson’s disease. Patients receiving treatments targeted to this brain region, rather than to surrounding areas, experienced greater improvements in symptoms.

Brain network responsible for Parkinson’s disease identified

This is exactly the kind of high-quality science we love at Washington University in St. Louis, but credit for this amazing paper goes to @jianxunren.bsky.social and Hesheng Liu's group of Peking University.

"Parkinson’s is not just a movement problem involving one body part. This study shows it is a whole-body brain network disorder that links movement, thinking, arousal and internal body control." —Michael Okun, neurologist at the University of Florida and medical director of the Parkinson’s Foundation

Scientists just discovered a key brain network affected by Parkinson’s disease. The finding could change how doctors understand symptoms and lead to better treatments. 🧠 bit.ly/4qdpLMf

A new study suggests Parkinson’s may stem from disruptions in a little-known brain network, reshaping how doctors think about the disease. A new study suggests Parkinson’s may stem from disruptions in a little-known brain network, reshaping how doctors think about the disease.

A new study suggests Parkinson’s may stem from disruptions in a little-known brain network, reshaping how doctors think about the disease. trib.al/XFtsWKn

Not to knock deep brain stimulation, but this is just wild that @jianxunren.bsky.social can treat Parkinson's symptoms without a drug or a brain surgery. So cool to see what you can do with precision functional mapping of individual brain networks! Be sure to read the paper: doi.org/10.1038/s415...

I’m very excited about this new work describing the specific cortical-striatal circuits that are altered in Parkinson’s Disease and that should be targeted for optimal PD treatment.

www.nature.com/articles/s41...

Parkinson’s disease as a somato-cognitive action network disorder - Nature The substantia nigra and all Parkinson’s disease deep-brain stimulation targets are selectively connected to the somato-cognitive action network rather than to effector-specific motor regions.

Incredible work by @jianxunren.bsky.social placing the subcortical Parkinson's circuits into a cortical context using the somatocognitive action network, really changes how I think about PD! Excited to see SCAN stimulation already helping PD patients! Well worth a read: doi.org/10.1038/s415...

Modafinil Modafinil is a non-amphetamine central nervous system stimulant with wakefulness-promoting properties. It is used in the treatment of conditions which cause excessive daytime sleepiness. In the United...

A great question! The pharmacology of modafinil is a little different from amphetamine-derived stimulants, but both seem to increase dopamine and norepinephrine. It would be interesting to do an fMRI study of modafinil to better understand its mechanism.
www.ncbi.nlm.nih.gov/books/NBK531...

Child neurologist and lead author of the study here. For those bashing the NPR title, of course stimulants help children and adults with ADHD (or I wouldn't offer them to my patients)! Read the article, it's about how they increase motivation more than attentional capacity. doi.org/10.1016/j.ce...

We saw a significant ADHD x sleep interaction, which is fancy math speak for the ADHD brain needing more than just sleep. That being said, many of my ADHD patients also have disordered sleep and feel better if we address their sleep issues, stimulant or not.

That's right, but it's more than just semantic. Stimulants won't help with something you already find rewarding, unless they're covering up a sleep deficit.

Yes, I believe there's active interest in using methylphenidate to treat addiction. doi.org/10.3389/fpsy...

That's exactly right Maia! What's new here is that stimulant medications are doing primarily this, and not actually making people "smarter" or increasing their capacity to pay attention.

That's hard to say, since ADHD is a heterogenous disorder with more than one subtype.
doi.org/10.3389/fnsy...
But yes, it's increasingly clear that for some people diagnosed with ADHD, it's more a deficit of motivation to perform mundane actions than attentional ability.
doi.org/10.1038/mp.2...

That's right, stimulants modulated the SAME brain networks in study participants with and without ADHD. HOWEVER, they appeared to improve cognition (e.g. school grades) only in participants who had ADHD or whose cognition was impaired by inadequate sleep.

Caffeine and stimulants don't have the same pharmacology, so I wouldn't necessarily expect them to make you feel the same way! That being said, there is actually good evidence that stimulants can indeed make you feel like you're doing great without actually making you great doi.org/10.1016/j.ne...

We did see the suggestion of increased FC between NAcc and frontostriatal reward regions in some of the precision participants, but not necessarily so with salience regions. So it's possible high-dose MTP gives the feeling of reward through NAcc while its effects on salience are cortically mediated.

The apparent lack of NAcc effect drove us nuts. We spent months trying to generate something publication quality. Decreased fMRI signal-to-noise in subcortex in the ABCD data was a limiting factor. I don't know that we were powered to say there isn't an affect of stimulants on NAcc.

Great observation, someone should do that experiment in humans! In the paper, we also wonder if stimulants make fMRI BOLD activation equal for large and small anticipated rewards in a monetary incentive delay task.

ADHD drugs work indirectly to improve attention New research suggests that prescription stimulants for ADHD don't actually improve attention directly. They work on different pathways in the brain that support attention. .

Appreciate the excellent (as usual) science reporting by NPR's Jon Hamilton highlighting our work showing stimulants affect arousal and reward, without directly affecting the brain's attention networks! www.npr.org/2025/12/24/n...
Read the whole story in Cell doi.org/10.1016/j.ce...

It's a baseball analogy for when someone who isn't in the batting line-up substitutes in, e.g. for a batter with an injury. The pinch hitter might hit a home run, but the pathway for the brain to get there is different from the typical pathway.

Also see work by Ryan Raut and Catie Chang on brain patterns of arousal. (Why don't they have BlueSky accounts yet?)

A somato-cognitive action network alternates with effector regions in motor cortex - Nature Functional MRI studies across ages show that the classic homunculus of the motor cortex in humans is in fact discontinuous, alternating with action control-linked regions termed the somato-cognitive ...

Oh @gordonneuro.bsky.social, if only someone would discover some kind of action-oriented network embedded within classical somatomotor cortex that controls sympathetic outflow and thus directly modulates arousal, upsetting decades of medical textbook homunculi...
doi.org/10.1038/s415...

Thanks Leah, several of the authors take stimulants themselves, so we had fun with this one! Always nice when brain science can give us greater insight into ourselves. Would love to chat about it more!

Yeah, we talk about the combination of arousal and reward being subjectively experienced as "motivation," kind of like you might drink coffee and have a candy bar to get started on your tax return.

Stimulants don't increase your capacity to pay attention, but they "pinch hit" for ADHD brains by making the mundane seem more interesting.

💡 Pretty remarkable, right? But sleep is still super-important for brain health, just ask @jonykipnis.bsky.social! Stay tuned for more research on what happens if you override your sleep drive for too long...

Thanks @roberthermosillo.bsky.social, I'm looking forward to the upcoming work on stimulants coming out of your lab!