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Results demonstrate increased activity in attention-related brain networks treated with BrainsWay’s H6-coil, which may correlate to observed improvement in ADHD symptoms
PATTERSON, N.J., February 10, 2020 — BrainsWay Ltd. (NASDAQ & TASE: BWAY) (“BrainsWay”) today announced results from a randomized controlled double-blind clinical trial (NCT01196910) assessing the safety and efficacy of the Company’s proprietary H6-coil deep transcranial magnetic stimulation (dTMS) System for the treatment of adults with attention deficit hyperactivity disorder (ADHD). Researchers at Tel Aviv Sourasky Medical Center, Tel Aviv University, Ben Gurion University and BrainsWay conducted the study, which used functional magnetic resonance imaging (fMRI) to assess the effect of dTMS on clinical, cognitive and neural activity in adults with ADHD. Results showed a statistically significant improvement in patient-reported assessments of inattention, together with a significant increase in activity that was observed within the dorsolateral prefrontal cortex (DLPFC), a part of the brain previously shown to have reduced activity in adults with ADHD.
“Reduced activity of the DLPFC, a brain region that controls the ability to respond to changing attentional demands, has previously been observed in patients with ADHD,” said Dr. Maya Bleich-Cohen, senior investigator at Tel Aviv Sourasky Medical Center and an investigator on the study. “The results of this initial study indicate that dTMS can be effective in modulating the DLPFC and that this may be a feasible technique to improve attention symptoms in adults with ADHD. Additional study of this non-invasive treatment approach in this population is warranted.”
About the Study
The study enrolled 75 adults, ages 18-60 years, with ADHD who had not previously received TMS. The study included one treatment group with the coil placed over the right DLPFC (N=27), a second group with the coil placed over the left DLPFC (N=28), and a sham group (N=20). Participants underwent a treatment phase consisting of 15 daily dTMS sessions, which were conducted five days a week for three consecutive weeks using the BrainsWay dTMS H6-coil. Each patient underwent fMRI before and after the treatment phase. Two additional treatment sessions were performed at the second and third follow-up visits (after eight and 12 weeks, respectively). At each treatment session, subjects also performed six minutes of computerized cognitive training consisting of an immediate recall task and a sustained attention task, each of three-minute duration. Patients underwent clinical evaluation at screening, after the three-week treatment phase and then at four and eight weeks after completion of the treatment phase, which included symptom assessment using validated questionnaires, and a full cognitive assessment including evaluation of memory, executive function and attention skills.
Topline findings from the study include:
• Significant improvements were observed in the Inattention/Memory Problems subscale of the Conners’ Adult ADHD Rating Scale (CAARS) self-report questionnaire, in both right and left treatment arms compared with the placebo group (p=.033)
o In a post-hoc analysis, improvements in the right and left stimulation groups were each significantly greater than the sham group (p<0.00005 and p<0.05, respectively)
• Interestingly, increased fMRI brain activation in the right DLPFC during the working memory task were only apparent following treatment in the right stimulation group (p=0.01)
o In a post-hoc analysis, activation in the right stimulation group was greater than the left stimulation or sham groups (p<0.005)
o Additionally, this increased right DLPFC activation was associated with larger symptom improvement exclusively in the right stimulation group (p<0.05)
o Other regions associated with the brain’s attentional network showed similar increased activation during the task in the right stimulation group (i.e. Right Inferior Parietal Sulcus, Right Inferior Frontal Gyrus)
• The response rates (defined as at least a 25% reduction in the CAARS observer questionnaire) measured one month following treatment were 26%, 23% and 18% for the right, left and sham arms, respectively. These differences, however, were not statistically significant in the limited sample size of this feasibility study
• No serious adverse events were reported in the study
The authors, led by principal investigator Elissa L. Ash, MD, from Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine at Tel Aviv University, are preparing the data for publication in a peer-reviewed forum.
“The medications commonly used to treat adults with ADHD have adverse side effects that may lead to treatment discontinuation have been reported in approximately 50% of patients,” said Christopher R. von Jako, president and CEO of BrainsWay. “dTMS with our H1 and H7-coils has been shown to provide benefit in the treatment of major depressive disorder and obsessive-compulsive disorder, respectively, and this initial feasibility study with our proprietary H6-coil suggests that it may provide benefit in the treatment of adults with ADHD. This study underscores our ability to innovate new coils and technologies that can potentially be optimized to the specific neurologic features of particular diseases. We are excited for the potential of dTMS in the treatment of adults with ADHD and will continue to evaluate this non-invasive approach in this patient population.”
This study adds to the growing body of clinical evidence demonstrating the potential clinical benefits of dTMS in the treatment of ADHD. A prior study, results of which were reported in 2016, compared dTMS using the BrainsWay H6-coil with standard TMS using a figure-8 coil or sham TMS to the right DLPFC. In that study, the percentage of patients who showed a reduction of 30% or more in the CAARS observer questionnaire was 33% in the dTMS group, 8% in the sham group, and 15% in the standard TMS group. A significant average improvement of 8.25 points (p=0.0001) was observed in total CAARS scores in the dTMS group compared with pre-treatment baseline values, and no significant changes were observed in the standard TMS or sham groups. These findings suggested a substantial therapeutic advantage for deep and widespread stimulation of the DLPFC with BrainsWay’s proprietary H6-coil over stimulation with a standard figure-8 coil in patients with ADHD.
Additionally, results of another study comparing dTMS with the H6-coil to active and sham controls found that only the H6 group had a significant improvement in CAARS scores. These study results, which demonstrate the clinical benefit of right PFC stimulation in adults with ADHD using the same H6-coil as was used in the current study, have been accepted for publication in a peer-reviewed medical journal.
ADHD is characterized as a disorder with an ongoing pattern of inattention and/or hyperactivity that can negatively impact a person’s quality of life and how they function at school, work and socially. It is estimated that ADHD affects nearly 1-in-10 adults in the United States in their lifetimes. Current treatments for ADHD are primarily stimulant medications that are often associated with risks and side effects, especially if misused or abused. It is estimated that approximately 5 million American adults are misusing prescription stimulants.
BrainsWay is engaged in the research, development and sales and marketing of a medical system for non-invasive treatment of common brain disorders. The medical system developed and manufactured by the company is based on a unique breakthrough technology called Deep TMS, which can reach significant depth and breadth of the brain and produce broad stimulation and functional modulation of targeted brain areas. In the U.S., the Company’s device has been FDA cleared for the treatment of major depressive disorder (MDD) and of Obsessive Compulsive Disorder (OCD). The Company’s systems have also received CE clearance and are used worldwide for the treatment of various brain disorders.