Noninvasive brain stimulation in ADHD: a meta-analysis of treatment efficacy and targeting trategies
Poster No:
285
Submission Type:
Abstract Submission
Authors:
Qiuxing Chen1, Yajing Long2, Nanfang Pan3, Ying Chen2, Qiyong Gong2
Institutions:
1West China Hospital of Sichuan University, Chengdu, China, 2Huaxi MR Research Center, Chengdu, Sichuan, 3Monash University, Melbourne, Victoria
First Author:
Co-Author(s):
Introduction:
Psychostimulant medications are widely prescribed for attention-deficit/hyperactivity disorder (ADHD), one of the most prevalent neurodevelopmental conditions affecting children (Salari et al., 2023). However, these medications demonstrate variable efficacy, with some individuals showing limited response and experiencing adverse effects (Torgersen et al., 2008; Golmirzaei et al., 2016). Non-invasive brain stimulation (NIBS) has emerged as a promising alternative treatment for ADHD. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are the two main methods of NIBS. However, the precise effects of NIBS in ADHD, as well as optimal stimulation protocols, remain elusive. This study aimed to summarize existing research, provide a critical assessment and quantitative evidence regarding the effects of NIBS on ADHD, and investigate the potential impact of different stimulation targets and treatment duration on their efficacy.
Methods:
We conducted a systematic literature search in PubMed, Web of Science, and Embase, using "ADHD" in combination with "tDCS" or "rTMS" as keywords. Additionally, we manually searched the reference lists of previously related meta-analyses. A total of 33 original studies were included: 7 for rTMS, and 26 for tDCS, with a total of 1049 individuals with ADHD enrolled (727 males, mean age ± standard deviation = 19.91 ± 12.44 years). We conducted a random-effects meta-analysis to estimate the effect of NIBS by calculating Hedges's g values as the standardized mean difference in clinical and cognitive measures of ADHD. In order to reduce heterogeneity, we divided clinical symptoms and cognitive function into different domains and conducted independent meta-analyses of each domain and two stimulation methods. Clinical symptoms were divided into two aspects: inattention and hyperactivity/impulsivity, while cognitive function was divided into four aspects: attention, inhibition control, processing speed, and working memory. Due to the sufficient number of tDCS studies (n > 10), a meta-regression analysis was conducted to evaluate cognitive function. Similarly, given the sufficient number of tDCS studies investigating cognitive outcomes (attention and inhibitory control), subgroup analyses were conducted to examine the effects of different stimulation targets.
Results:
rTMS was effective in improving inattention symptoms (Hedges' g = -1.17, 95% CI [-2.33, - 0.02], p = 0.046) and attention-related function (Hedges's g = 0.53, 95% CI [0.07, 1.00], p = 0.023), while tDCS showed therapeutic benefits in improving hyperactivity/impulsivity symptoms (Hedges's g = -0.28, 95% CI [-0.52, -0.04], p = 0.024) and inhibitory control function (Hedges' g = 0.39, 95% CI [0.04, 0.73], p = 0.028). tDCS applying anodal stimulation to the left dorsolateral prefrontal cortex (DLPFC) and the cathodal stimulation to the right orbitofrontal cortex (OFC) demonstrated significant effects in improving inhibitory control. No significant dose-response relationship was found between tDCS intervention duration and cognitive outcomes in ADHD.
Conclusions:
NIBS is a promising therapeutic approach to alleviating clinical symptoms and enhancing cognitive functions in individuals with ADHD. The selection of stimulation targets emerges as a critical determinant of therapeutic outcomes, whereas treatment duration does not appear to influence treatment efficacy. Moving forward, future research should focus on optimizing NIBS protocols and investigating the comparative advantages of different NIBS technologies, ultimately advancing the practical therapeutic application of NIBS for ADHD management.
Brain Stimulation:
Non-invasive Electrical/tDCS/tACS/tRNS 2
Non-invasive Magnetic/TMS
Disorders of the Nervous System:
Neurodevelopmental/ Early Life (eg. ADHD, autism) 1
Higher Cognitive Functions:
Executive Function, Cognitive Control and Decision Making
Keywords:
Attention Deficit Disorder
Meta- Analysis
Transcranial Magnetic Stimulation (TMS)
Treatment
Other - non-invasive brain stimulation; repetitive transcranial magnetic stimulation; transcranial direct current stimulation
1|2Indicates the priority used for review
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Provide references using APA citation style.
Salari, N. (2023). The global prevalence of ADHD in children and adolescents: A systematic review and meta-analysis. Italian Journal of Pediatrics, 49, 48.
Torgersen, T. (2008). Treatment of adult ADHD: Is current knowledge useful to clinicians? Neuropsychiatric Disease and Treatment, 4(1), 177–186.