Dataset Information

A meta-analysis on the therapeutic efficacy of repetitive transcranial magnetic stimulation for cognitive functions in attention-deficit/hyperactivity disorders.

ABSTRACT:

Background

Therapeutic efficacies of repetitive transcranial magnetic stimulation (rTMS) for improving cognitive functions in patients with deficit/hyperactivity disorder (ADHD) remained unclear. The aim of this meta-analysis was to investigate the therapeutic efficacy of rTMS focusing on different cognitive performances.

Methods

Major databases were searched electronically from inception to February 2023 by using keywords mainly "rTMS" and "ADHD" to identify randomized controlled trials (RCTs) that investigated the therapeutic efficacy of rTMS for improving cognitive functions assessed by standardized tasks in patients with ADHD. The overall effect size (ES) was calculated as standardized mean difference (SMD) based on a random effects model.

Results

Meta-analysis of five RCTs with 189 participants (mean age of 32.78 and 8.53 years in adult and child/adolescent populations, respectively) demonstrated that rTMS was more effective for improving sustained attention in patients with ADHD compared with the control groups (SMD = 0.54, p = 0.001).Our secondary analysis also showed that rTMS was more effective for improving processing speed than the control groups (SMD = 0.59, p = 0.002) but not for enhancing memory or executive function.

Conclusions

Our results supported the therapeutic efficacy of rTMS for improving sustained attention and processing speed. However, the limitation of available data warrants further studies to verify these findings.

SUBMITTER: Chen YH

PROVIDER: S-EPMC10580630 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

A meta-analysis on the therapeutic efficacy of repetitive transcranial magnetic stimulation for cognitive functions in attention-deficit/hyperactivity disorders.

Chen Ying-Hsin YH Liang Shun-Chin SC Sun Cheuk-Kwan CK Cheng Yu-Shian YS Tzang Ruu-Fen RF Chiu Hsien-Jane HJ Wang Ming-Yu MY Cheng Ying-Chih YC Hung Kuo-Chuan KC

BMC psychiatry 20231017 1

<h4>Background</h4>Therapeutic efficacies of repetitive transcranial magnetic stimulation (rTMS) for improving cognitive functions in patients with deficit/hyperactivity disorder (ADHD) remained unclear. The aim of this meta-analysis was to investigate the therapeutic efficacy of rTMS focusing on different cognitive performances.<h4>Methods</h4>Major databases were searched electronically from inception to February 2023 by using keywords mainly "rTMS" and "ADHD" to identify randomized controlled ...[more]

PMID: 37845676

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Project description:BackgroundTranscranial magnetic stimulation (TMS) is a promising neuromodulation technique that has been widely used in neuropsychiatric disorders, but there was no evidence on its effect on the improvement attention-deficit hyperactivity disorder (ADHD).ObjectiveThis systematic review and meta-analysis aimed to investigate the efficacy and safety of TMS in reducing ADHD symptoms.MethodWe systematically searched four databases (PubMed, Embase, Web of Science, and Cochrane Library databases) for randomized controlled/crossover trials on the efficacy and safety of TMS on ADHD symptom improvement compared to sham rTMS or non-TMS interventions, published until September 18, 2024. Extracted data from the included studies involved patient characteristics, intervention protocols, and main outcomes. The effect size of the TMS treatment was evaluated using the standardized mean difference (SMD) with a 95% confidence interval (CI), calculated with either a random effects model or fixed effects model depending on the level of heterogeneity.ResultEight studies (325 ADHD patients in total) were included in this systematic review and meta-analysis. According to the core symptoms, TMS significantly improved inattention (SMD = -0.94, 95% CI = -1.33 to -0.56, p < 0.001) and hyperactivity/impulsivity (SMD = -0.98, 95% CI = -1.27 to -0.69, p < 0.001) compared to non-TMS interventions after 3-6 weeks of intervention. During the 1-month follow-up, the TMS group still demonstrated a significant improvement in inattention symptoms compared to the non-TMS group (SMD = -0.67, 95% CI = -1.06 to 0.28, p < 0.001). The total symptoms in the TMS group only showed improvement in the 1-month follow-up compared to the non-TMS group. (SMD = -0.48, 95% CI = -0.82 to -0.14, p = 0.005). Only minor adverse events were reported in the included studies, comprising headache and scalp discomfort.ConclusionTMS significantly improved the inattention, hyperactivity/impulsivity, and total symptom scores in ADHD patients with minor adverse events. Future research should focus on the association between different brain regions and symptoms in ADHD patients, which is crucial for stimulation navigation in TMS interventions. The trial is registered in PROSPERO (PROSPERO registry number: CRD42023473853).

Project description:Background/objectivesAttention-deficit/hyperactivity disorder (ADHD) currently lacks a universally accepted biomarker or diagnostic test, underscoring the need for objective and effective assessment methods. Transcranial magnetic stimulation (TMS) has emerged as a promising tool for both assessing cortical excitability and providing therapeutic interventions. This study conducted two independent meta-analyses to evaluate: 1) the potential of TMS in assessing cortical excitability, and 2) its therapeutic efficacy in managing ADHD symptoms.MethodsA systematic search was conducted in EMBASE, MEDLINE, PsycINFO, ClinicalTrials, and PubMed following PRISMA guidelines. The "cortical excitability" meta-analysis included studies comparing TMS-EMG or TMS-EEG neurophysiological measures between ADHD patients and healthy controls. The "therapeutic" meta-analysis focused on randomized controlled trials (RCTs) evaluating repetitive TMS (rTMS) effects on ADHD symptoms. Standardized mean differences (SMDs) were calculated for pooled effect sizes.ResultsIn the "cortical excitability" meta-analysis, 17 studies were included, demonstrating significantly reduced short-interval intracortical inhibition (SICI) in ADHD compared to healthy controls (pooled SMD = 0.65, 95% CI: 0.41-0.88, P < 0.00001). No significant differences were observed for motor evoked potentials (MEP), motor thresholds (aMT/rMT), cortical silent period (cSP), ipsilateral silent period (iSP), or intracortical facilitation (ICF). The "therapeutic" meta-analysis, encompassing 8 samples from 7 studies, demonstrated that rTMS significantly improved ADHD symptoms compared to control conditions (pooled SMD = 0.45, 95% CI: 0.19-0.70, P = 0.0006).ConclusionsThis study highlights the potential of TMS as both a diagnostic and therapeutic tool in ADHD. Reduced SICI appears to be a key neurophysiological marker of ADHD, reflecting cortical GABAergic dysfunction. Additionally, rTMS shows promise in alleviating ADHD symptoms, though further studies are needed to confirm long-term therapeutic benefits and optimize stimulation protocols.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024507867.

Project description:ImportanceTranscranial direct current stimulation (tDCS) has the potential to be a sustainable treatment option in pediatric attention-deficit/hyperactivity disorder (ADHD), but rigorously controlled multicenter clinical trials using state-of-the-art stimulation techniques are lacking.ObjectivesTo determine effect sizes of changes in cognitive and clinical measures and to assess safety and tolerability in the course of optimized multichannel tDCS over prefrontal target regions in pediatric ADHD.Design, setting, and participantsIn the sham-controlled, double-blind, parallel-group randomized clinical trial E-StimADHD (Improving Neuropsychological Functions and Clinical Course in Children and Adolescents With ADHD With Anodal Transcranial Direct Current Stimulation of the Prefrontal Cortex: A Randomized, Double-Blind, Sham-Controlled, Parallel Group Trial Using an Uncertified Class IIa Device) with 2 independent study arms, participants were enrolled from September 15, 2018, to August 10, 2021, and follow-up was completed October 4, 2021. Data were analyzed January 26, 2022, to November 8, 2023. The trial was conducted at the departments of child and adolescent psychiatry or pediatrics of 5 university hospitals in Portugal and Germany. Youths 10 to 18 years of age with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (all presentations), an IQ of at least 80, and the ability to refrain from stimulant medication during participation in the trial were eligible.InterventionsOptimized multichannel anodal tDCS or sham stimulation (1 mA, 20 minutes) targeting the left dorsolateral prefrontal cortex (lDLPFC; study A) or the right inferior frontal gyrus (rIFG; study B) was applied in 10 sessions, concurrent with performance on a cognitive target task (study A, working memory assessed in the n-back task; study B, interference control assessed in the flanker task).Main outcomes and measuresEffect sizes for changes in accuracy measures (d-prime or flanker effect) in the target tasks assessed after the intervention. Primary analyses were based on the modified intention-to-treat set.ResultsThis study included 69 youths (54 [78%] male) with a median age of 13.3 years (IQR, 11.9-14.9 years). Compared with sham tDCS, verum stimulation of the lDLPFC led to significantly lower working memory accuracy (effect size, -0.43 [95% CI, -0.68 to -0.17]; P = .001). Stimulation of the rIFG significantly improved interference control (effect size, 0.30 [95% CI, 0.04-0.56]; P = .02). Adverse events were mostly mild and transient and did not occur more often in the verum group. For example, the most frequent adverse events were headache (sham, n = 30; verum, n = 20), nasopharyngitis (sham, n = 11; verum, n = 5), and feeling of electric discharge (sham, n = 5; verum, n = 3).Conclusions and relevanceIn this randomized clinical trial, prefrontal anodal tDCS induced small- to medium-sized effects in youths with ADHD, with only mild and transient adverse events. The optimized multichannel montage chosen to target the lDLPFC, however, decreased working memory performance. This unexpected finding stresses the importance of incorporating insights from basic research on the mechanisms and preconditions of successful tDCS in future study designs to advance application of tDCS in pediatric ADHD.Trial registrationGerman Clinical Trials Register ID: DRKS00012659.

Project description:Transcranial direct current stimulation (tDCS) is a promising method for altering cortical excitability with clinical implications in neuropsychiatric diseases. Its application in neurodevelopmental disorders especially attention-deficit hyperactivity disorder (ADHD), is in early stage and promising but its effectiveness has not been systematically examined yet. We conducted a meta-analysis on the effectiveness of tDCS on the most studied neuropsychological symptoms of ADHD, which is the first reported meta-analysis of tDCS studies on ADHD. Data from 10 randomized controlled studies (including 11 separate experiments) targeting inhibitory control, and/or working memory (WM) in ADHD were included. Results show that overall tDCS significantly improved inhibitory control. Sub-analyses further show that dorsolateral prefrontal cortex (dlPFC) (but not right inferior frontal gyrus) tDCS and anodal (but not cathodal) tDCS significantly improved inhibitory control with a small effect size. Anodal dlPFC-tDCS had the largest significant effect on inhibitory control with a small-to-medium effect size. Additionally, a significant improving effect of tDCS on inhibitory control accuracy (but not response time) and WM speed (but not accuracy) were found. Overall, this meta-analysis supports a beneficial effect of tDCS on inhibitory control and WM in ADHD with a small-to-medium effect size. TDCS seems to be a promising method for improving neuropsychological and cognitive deficits in ADHD. However, there might be a dissociation between neuropsychological deficits and clinical symptoms of ADHD and therefore, the significance of this meta-analysis for clinical purposes is limited. Future studies should systematically evaluate the role of inter-individual factors (i.e., ADHD subtype, types of the deficit) and stimulation parameters (i.e., site, polarity, intensity, duration, repetition rate) on tDCS efficacy in ADHD population and examine whether benefits are long-term.

Project description:BackgroundVisuospatial attention is executed by the frontoparietal cortical areas of the brain. Damage to these areas can result in visual neglect. We therefore aimed to assess a combination of the greyscales task and repetitive navigated transcranial magnetic stimulation (rTMS) to identify cortical regions involved in visuospatial attention processes. This pilot study was designed to evaluate an approach in a cohort of healthy volunteers, with the future aim of using this technique to map brain tumor patients before surgery. Ten healthy, right-handed subjects underwent rTMS mapping of 52 cortical spots in both hemispheres. The greyscales task was presented tachistoscopically and was time-locked to rTMS pulses. The task pictures showed pairs of horizontal rectangles shaded continuously from black at one end to white at the other, mirror-reversed. On each picture the subject was asked to report which of the two greyscales appeared darker overall. The responses were categorized into "leftward" and "rightward," depending on whether the subject had chosen the rectangle with the darker end on the left or the right. rTMS applied to cortical areas involved in visuospatial attention is supposed to affect lateral shifts in spatial bias. These shifts result in an altered performance on the greyscales task compared to the baseline performance without rTMS stimulation.ResultsIn baseline conditions, 9/10 subjects showed classic pseudoneglect to the left. Leftward effects also occurred more often in mapping conditions. Yet, calculated rightward deviations were strikingly greater in magnitude (p < 0.0001). Overall, the right hemisphere was found to be more suggestible than the left hemisphere. Both rightward and leftward deviation scores were higher for the rTMS of this brain side (p < 0.0001). Right hemispheric distributions accord well with current models of visuospatial attention (Corbetta et al. Nat Neurosci 8(11):1603-1610, 2005). We observed leftward deviations triggered by rTMS within superior frontal and posterior parietal areas and rightward deviations within inferior frontal areas and the temporoparietal junction (TPJ).ConclusionThe greyscales task, in combination with rTMS, yields encouraging results in the examination of the visuospatial attention function. Future clinical implications should be evaluated.

Dataset Information

A meta-analysis on the therapeutic efficacy of repetitive transcranial magnetic stimulation for cognitive functions in attention-deficit/hyperactivity disorders.

Background

Methods

Results

Conclusions

Publications

A meta-analysis on the therapeutic efficacy of repetitive transcranial magnetic stimulation for cognitive functions in attention-deficit/hyperactivity disorders.

Similar Datasets

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