A functional magnetic resonance imaging investigation of prefrontal cortex deep transcranial magnetic stimulation efficacy in adults with attention deficit/hyperactive disorder: A double blind, randomized clinical trial

Journal: NeuroImage: Clinical 30:102670 (2021)

Authors: M Bleich-Cohen, G Gurevitch, N Carmi, M Medvedovsky, N Bregman, N Nevler, K Elman, A Ginou, A Zangen, E.L Ash

Background:

ADHD is one of the most prevalent neurocognitive disorders. Deep TMS is a non-invasive neuromodulation tool that holds promise in treatment of neurocognitive disorders. Hypoactivity of the prefrontal cortex (PFC) has been observed in ADHD.

Objective:

This study examined the clinical, cognitive, and neural effects of Deep TMS to the PFC in adults with ADHD by using functional magnetic resonance imaging (fMRI).

Methods:

High frequency Deep TMS was applied to either the right or left PFC in 62 adults with ADHD in a randomized, double blind, placebo-controlled protocol with 3 study groups: 2 treatment arms (rPFC, or lPFC) and a Sham arm. The study included 15 Deep TMS/cognitive training treatment sessions. Clinical effects were assessed with the Conners Adult ADHD Rating Scale (CAARS) self-report and the Clinical Global Impression score (CGI) as primary outcome measures. Self-report/observer questionnaires and computerized cognitive testing were also performed to assess clinical and cognitive effects. Neural effects were assessed with fMRI using working-memory (WM) and resting-state paradigms.

Results:

While the study did not show improvement in the primary endpoints, significant improvements were observed in the CAARS (self-report) inattention/memory sub-scale, as well as increased activations in the rDLPFC, right parietal-cortex and right insula/IFG during WM conditions after treatment in the right stimulation group. Increased rDLPFC activation was associated with larger symptom improvement in the right stimulation group.

 

Conclusions:

This study indicates that Deep TMS is effective in modulating attention related brain networks and is a feasible technique that may improve attention symptoms in adults with ADHD.

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