Deep TMS Efficacy in Adults with Attention Deficit Disorder

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


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.


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).


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.


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.



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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