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Thiele C, Rufener KS, Repplinger S, Zaehle T, Ruhnau P. Transcranial temporal interference stimulation (tTIS) influences event-related alpha activity during mental rotation. Psychophysiology 2024:e14651. [PMID: 38997805 DOI: 10.1111/psyp.14651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/14/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
Non-invasive brain stimulation techniques offer therapeutic potential for neurological and psychiatric disorders. However, current methods are often limited in their stimulation depth. The novel transcranial temporal interference stimulation (tTIS) aims to overcome this limitation by non-invasively targeting deeper brain regions. In this study, we aimed to evaluate the efficacy of tTIS in modulating alpha activity during a mental rotation task. The effects of tTIS were compared with transcranial alternating current stimulation (tACS) and a sham control. Participants were randomly assigned to a tTIS, tACS, or sham group. They performed alternating blocks of resting and mental rotation tasks before, during, and after stimulation. During the stimulation blocks, participants received 20 min of stimulation adjusted to their individual alpha frequency (IAF). We assessed shifts in resting state alpha power, event-related desynchronization (ERD) of alpha activity during mental rotation, as well as resulting improvements in behavioral performance. Our results indicate tTIS and tACS to be effective in modulating cortical alpha activity during mental rotation, leading to an increase in ERD from pre- to poststimulation as well as compared to sham stimulation. However, this increase in ERD was not correlated with enhanced mental rotation performance, and resting state alpha power remained unchanged. Our findings underscore the complex nature of tTIS and tACS efficacy, indicating that stimulation effects are more observable during active cognitive tasks, while their impacts are less pronounced on resting neuronal systems.
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Affiliation(s)
- Carsten Thiele
- Department of Neurology, Otto-von-Guericke-University, University Clinic of Magdeburg, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Katharina S Rufener
- Center for Behavioral Brain Sciences (CBBS), Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine of Childhood and Adolescents, Otto-von-Guericke-University, University Clinic of Magdeburg, Magdeburg, Germany
| | - Stefan Repplinger
- Department of Neurology, Otto-von-Guericke-University, University Clinic of Magdeburg, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke-University, University Clinic of Magdeburg, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Philipp Ruhnau
- Center for Behavioral Brain Sciences (CBBS), Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
- School of Psychology and Humanities, University of Central Lancashire, Preston, UK
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Ghahri Lalaklou Z, Haghighat-Manesh E, Montazeri Ghahjavarestani A, Ahmadi E. The effect of transcranial alternating current stimulation on cognitive flexibility and attention of children with intellectual disability: a case report. J Med Case Rep 2024; 18:310. [PMID: 38965608 PMCID: PMC11225214 DOI: 10.1186/s13256-024-04625-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/07/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Intellectual disability is a neurodevelopmental disorder characterized by significant impairments in intellectual functioning and adaptive behavior. Cognitive flexibility and attention are crucial cognitive domains often affected in children with intellectual disability. This case report explores the novel use of transcranial alternating current stimulation, a noninvasive brain stimulation technique, to enhance these cognitive functions. The study's novelty lies in its focus on alpha-wave frequency transcranial alternating current stimulation targeting specific Brodmann areas and its potential sustained impact on cognitive flexibility and attention in the pediatric population with intellectual disability. CASE PRESENTATION The case study involved two elementary school students, both 7 years old with mild intellectual disability, one male and one female, both with Turkic ethnicity, from Shahid Fahmideh School for Exceptional Children in Khosrowshah, Iran. Both participants underwent a 2-week intervention with daily 20-minute sessions of transcranial alternating current stimulation at an alpha-wave frequency (10 Hz), targeting Brodmann areas F3 and P3. Cognitive flexibility and attention were assessed using the Wisconsin Card Sorting Test and the Clock Test, administered at four time points: pre-intervention, week 1, week 2, and 1 month post-intervention. Statistical analysis showed significant improvements in both Wisconsin Card Sorting Test and Clock Test scores for both participants compared with baseline, with sustained enhancement over time. CONCLUSION The findings from this case report indicate that transcranial alternating current stimulation may be a promising intervention for improving cognitive flexibility and attention in children with intellectual disability. The significant and sustained improvements observed suggest that transcranial alternating current stimulation could have a meaningful clinical impact on the cognitive development of this population. However, further research is needed to confirm the efficacy of transcranial alternating current stimulation and to explore its broader applicability and long-term effects in larger, more diverse populations.
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Affiliation(s)
- Zahra Ghahri Lalaklou
- Faculty of Psychology and Educational Sciences, Azarbaijan Shahid Madani University, Tabriz, Iran.
| | - Elahe Haghighat-Manesh
- Department of Basic Sciences, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | | | - Ezzatollah Ahmadi
- Faculty of Psychology and Educational Sciences, Azarbaijan Shahid Madani University, Tabriz, Iran.
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Vöckel J, Kühnel A, Rossberg R, Geist N, Sigrist C, Pokorny L, Koenig J, Kroemer N, Bender S. Transcranial direct current stimulation enhances effort maintenance in ADHD. Brain Stimul 2024; 17:899-906. [PMID: 39089646 DOI: 10.1016/j.brs.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 07/19/2024] [Accepted: 07/28/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Youth with attention-deficit/hyperactivity disorder (ADHD) exhibit increased effort aversion, likely due to deficits in anticipatory dopamine firing. Previous research has shown that transcranial direct current stimulation (tDCS) targeting the right prefrontal cortex can enhance activity in dopaminergic meso-striatal regions. However, the extent to which this specific tDCS configuration effectively modulates effort behavior in anticipation of rewards in ADHD remains uncertain. HYPOTHESIS We expected an increase of effort maintenance and invigoration during and following our tDCS set-up compared to sham in subjects with ADHD. METHODS Twenty-four children and adolescents with ADHD (mean age: 11.6 years; 95 % CI [10.7, 12.4]) received 2 mA and sham tDCS for 20 min each. The anode was positioned over the ventromedial prefrontal cortex (PFC), while the cathode was placed over the right dorsolateral PFC, generating an electrical field with maximal strength in the right PFC. During and after the tDCS sessions, participants performed a button-pressing task aimed at earning delayed monetary rewards. Primary outcomes were effort maintenance (frequency of button presses) and invigoration (slopes of button presses), measuring motor task performance. RESULTS We observed a significant increase in effort maintenance both during (b = 2.66; p < 0.001) and after tDCS (b = 2.04; p= .007) compared to sham. No significant difference was found for invigoration during stimulation, while after bonferroni correction (p = 0.025) a non-significant decrease was found after tDCS compared to sham (b = -5.18; p = 0.041). CONCLUSION tDCS targeting the ventromedial PFC (anodal) and right dorsolateral PFC (cathodal) increases effort maintenance in children and adolescents with ADHD.
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Affiliation(s)
- Jasper Vöckel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany.
| | - Anne Kühnel
- Section of Medical Psychology, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Rebecca Rossberg
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Nina Geist
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Christine Sigrist
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Lena Pokorny
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Nils Kroemer
- Section of Medical Psychology, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany; Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany; German Center for Mental Health (DZPG), Germany
| | - Stephan Bender
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
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Nejati V, Estaji R. The impact of transcranial direct current stimulation on attention bias modification in children with ADHD. J Neural Transm (Vienna) 2024; 131:823-832. [PMID: 38643330 DOI: 10.1007/s00702-024-02775-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/30/2024] [Indexed: 04/22/2024]
Abstract
Individuals with attention deficit-hyperactivity disorder (ADHD) struggle with the interaction of attention and emotion. The ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) are assumed to be involved in this interaction. In the present study, we aimed to explore the effect of stimulation applied over the dlPFC and vmPFC on attention bias in individuals with ADHD. Twenty-three children with ADHD performed the emotional Stroop and dot probe tasks during transcranial direct current stimulation (tDCS) in 3 conditions: anodal dlPFC (F3)/cathodal vmPFC (Fp2), anodal vmPFC (Fp2)/cathodal dlPFC (F3), and sham stimulation. Findings suggest reduction of attention bias in both real conditions based on emotional Stroop task and not dot probe task. These results were independent of emotional states. The dlPFC and vmPFC are involved in attention bias in ADHD. tDCS can be used for attention bias modification in children with ADHD.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, 1983969411, Tehran, Iran.
| | - Reza Estaji
- Department of Psychology, Shahid Beheshti University, 1983969411, Tehran, Iran
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Estaji R, Hosseinzadeh M, Arabgol F, Nejati V. Transcranial direct current stimulation (tDCS) improves emotion regulation in children with attention-deficit hyperactivity disorder (ADHD). Sci Rep 2024; 14:13889. [PMID: 38880826 PMCID: PMC11180663 DOI: 10.1038/s41598-024-64886-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024] Open
Abstract
Children with attention deficit/hyperactivity disorder (ADHD) typically exhibit difficulties in emotion regulation. It has been shown that the dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC) are crucially involved in these deficient processes. In this study, we aimed to explore the impact of electrical stimulation over the left dlPFC and right vmPFC on emotion regulation in children with ADHD. Twenty-four children with ADHD completed the Emotional Go/No-Go and Emotional 1-Back tasks while undergoing transcranial direct current stimulation (tDCS) in three separate sessions, each with a different electrode placement: anodal dlPFC (F3)/cathodal vmPFC (Fp2), anodal vmPFC (Fp2)/cathodal dlPFC (F3), and sham stimulation. During both real tDCS conditions, the accuracy of pre-potent inhibitory control and working memory performance improved, but not speed. This study provides evidence that the left dlPFC and the right vmPFC are involved in emotion regulation in ADHD.
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Affiliation(s)
- Reza Estaji
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Mariam Hosseinzadeh
- Department of Psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Arabgol
- Department of Psychiatry, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran.
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Gurr C, Splittgerber M, Puonti O, Siemann J, Luckhardt C, Pereira HC, Amaral J, Crisóstomo J, Sayal A, Ribeiro M, Sousa D, Dempfle A, Krauel K, Borzikowsky C, Brauer H, Prehn-Kristensen A, Breitling-Ziegler C, Castelo-Branco M, Salvador R, Damiani G, Ruffini G, Siniatchkin M, Thielscher A, Freitag CM, Moliadze V, Ecker C. Neuroanatomical Predictors of Transcranial Direct Current Stimulation (tDCS)-Induced Modifications in Neurocognitive Task Performance in Typically Developing Individuals. J Neurosci 2024; 44:e1372232024. [PMID: 38548336 PMCID: PMC11140687 DOI: 10.1523/jneurosci.1372-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/09/2024] [Accepted: 01/27/2024] [Indexed: 05/31/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique gaining more attention in neurodevelopmental disorders (NDDs). Due to the phenotypic heterogeneity of NDDs, tDCS is unlikely to be equally effective in all individuals. The present study aimed to establish neuroanatomical markers in typically developing (TD) individuals that may be used for the prediction of individual responses to tDCS. Fifty-seven male and female children received 2 mA anodal and sham tDCS, targeting the left dorsolateral prefrontal cortex (DLPFCleft), right inferior frontal gyrus, and bilateral temporoparietal junction. Response to tDCS was assessed based on task performance differences between anodal and sham tDCS in different neurocognitive tasks (N-back, flanker, Mooney faces detection, attentional emotional recognition task). Measures of cortical thickness (CT) and surface area (SA) were derived from 3 Tesla structural MRI scans. Associations between neuroanatomy and task performance were assessed using general linear models (GLM). Machine learning (ML) algorithms were employed to predict responses to tDCS. Vertex-wise estimates of SA were more closely linked to differences in task performance than measures of CT. Across ML algorithms, highest accuracies were observed for the prediction of N-back task performance differences following stimulation of the DLPFCleft, where 65% of behavioral variance was explained by variability in SA. Lower accuracies were observed for all other tasks and stimulated regions. This suggests that it may be possible to predict individual responses to tDCS for some behavioral measures and target regions. In the future, these models might be extended to predict treatment outcome in individuals with NDDs.
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Affiliation(s)
- Caroline Gurr
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main 60528, Germany
| | - Maike Splittgerber
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel 24105, Germany
| | - Oula Puonti
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre 2650, Denmark
| | - Julia Siemann
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, University of Bielefeld, Bielefeld 33617, Germany
| | - Christina Luckhardt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main 60528, Germany
| | - Helena C Pereira
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute for Nuclear Sciences applied to Health (ICNAS), Faculty of Medicine, Academic Clinical Centre, University of Coimbra, Coimbra 3000-548, Portugal
| | - Joana Amaral
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute for Nuclear Sciences applied to Health (ICNAS), Faculty of Medicine, Academic Clinical Centre, University of Coimbra, Coimbra 3000-548, Portugal
| | - Joana Crisóstomo
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute for Nuclear Sciences applied to Health (ICNAS), Faculty of Medicine, Academic Clinical Centre, University of Coimbra, Coimbra 3000-548, Portugal
| | - Alexandre Sayal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute for Nuclear Sciences applied to Health (ICNAS), Faculty of Medicine, Academic Clinical Centre, University of Coimbra, Coimbra 3000-548, Portugal
| | - Mário Ribeiro
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute for Nuclear Sciences applied to Health (ICNAS), Faculty of Medicine, Academic Clinical Centre, University of Coimbra, Coimbra 3000-548, Portugal
| | - Daniela Sousa
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute for Nuclear Sciences applied to Health (ICNAS), Faculty of Medicine, Academic Clinical Centre, University of Coimbra, Coimbra 3000-548, Portugal
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig Holstein, Kiel 24105, Germany
| | - Kerstin Krauel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg 39130, Germany
- German Center for Mental Health (DZPG), partner site Halle-Jena- Magdeburg, Magdeburg 39120, Germany
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig Holstein, Kiel 24105, Germany
| | - Hannah Brauer
- Department of Child and Adolescent Psychiatry, Center for Integrative Psychiatry Kiel, University Medical Center Schleswig-Holstein, Kiel 24105, Germany
| | - Alexander Prehn-Kristensen
- Department of Child and Adolescent Psychiatry, Center for Integrative Psychiatry Kiel, University Medical Center Schleswig-Holstein, Kiel 24105, Germany
| | - Carolin Breitling-Ziegler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg 39130, Germany
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute for Nuclear Sciences applied to Health (ICNAS), Faculty of Medicine, Academic Clinical Centre, University of Coimbra, Coimbra 3000-548, Portugal
| | | | | | | | - Michael Siniatchkin
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, University of Bielefeld, Bielefeld 33617, Germany
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre 2650, Denmark
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby 2800, Denmark
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main 60528, Germany
| | - Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel 24105, Germany
| | - Christine Ecker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main 60528, Germany
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Cheung T, Yee BK, Chau B, Lam JYT, Fong KH, Lo H, Li TMH, Li AM, Sun L, Beisteiner R, Cheng CPW. Efficacy and safety of transcranial pulse stimulation in young adolescents with attention-deficit/hyperactivity disorder: a pilot, randomized, double-blind, sham-controlled trial. Front Neurol 2024; 15:1364270. [PMID: 38784916 PMCID: PMC11112118 DOI: 10.3389/fneur.2024.1364270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Background This is the first study to evaluate the efficacy and safety of transcranial pulse stimulation (TPS) for the treatment of attention-deficit/hyperactivity disorder (ADHD) among young adolescents in Hong Kong. Methods This double-blind, randomized, sham-controlled trial included a TPS group and a sham TPS group, encompassing a total of 30 subjects aged 12-17 years who were diagnosed with ADHD. Baseline measurements SNAP-IV, ADHD RS-IV, CGI and executive functions (Stroop tests, Digit Span) and post-TPS evaluation were collected. Both groups were assessed at baseline, immediately after intervention, and at 1-month and 3-month follow-ups. Repeated-measures ANOVAs were used to analyze data. Results The TPS group exhibited a 30% reduction in the mean SNAP-IV score at postintervention that was maintained at 1- and 3-month follow-ups. Conclusion TPS is an effective and safe adjunct treatment for the clinical management of ADHD. Clinical trial registration ClinicalTrials.Gov, identifier NCT05422274.
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Affiliation(s)
- Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- The Mental Health Research Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Benjamin K. Yee
- The Mental Health Research Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Bolton Chau
- The Mental Health Research Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Joyce Yuen Ting Lam
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- The Mental Health Research Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kwan Hin Fong
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Herman Lo
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Tim Man Ho Li
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Albert Martin Li
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Lei Sun
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | | | - Calvin Pak Wing Cheng
- Department of Psychiatry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Alizadehgoradel J, Razavi SD, Shirani Z, Barati M, Taherifard M, Nejati V, Nitsche MA. Targeting the left DLPFC and right VLPFC in unmarried romantic relationship breakup (love trauma syndrome) with intensified electrical stimulation: A randomized, single-blind, parallel-group, sham-controlled study. J Psychiatr Res 2024; 175:170-182. [PMID: 38735262 DOI: 10.1016/j.jpsychires.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Ending a romantic relationship is one of the most painful losses an adult experience. Neuroimaging studies suggest that there is a neuropsychological link between breakup experiences and bereaved individuals, and that specific prefrontal regions are involved. The aim of this study was to determine whether enhancement of left DLPFC and right VLPFC activity with a novel intensified anodal transcranial direct current stimulation protocol reduces core symptoms of love trauma syndrome (LTS) and improves treatment-related variables. METHODS In this randomized, sham-controlled, single-blind parallel trial, we assessed the efficacy of an intensified anodal stimulation protocol (20 min, twice-daily sessions with 20 min intervals, 5 consecutive days) with two montages (left DLPFC vs right VLPFC) to reduce love trauma symptoms. 36 participants with love trauma syndrome were randomized in three tDCS condition (left DLPFC, right VLPFC, sham stimulation). LTS symptoms, treatment-related outcome variables (depressive state, anxiety, emotion regulation, positive and negative affect), and cognitive functions were assessed before, right after, and one month after intervention. RESULTS Both DLPFC and VLPFC protocols significantly reduced LTS symptoms, and improved depressive state and anxiety after the intervention, as compared to the sham group. The improving effect of the DLPFC protocol on love trauma syndrome was significantly larger than that of the VLPFC protocol. For emotion regulation and positive and negative affect, improved regulation of emotions and positive affect and reduced negative affect were revealed after intervention in the two real stimulation conditions compared to the sham. For cognitive functions, no significant difference was observed between the groups, but again a positive effect of intervention within groups in the real stimulation conditions (DLPFC and VLPFC) was found for most components of the cognitive tasks. CONCLUSIONS Enhancement of left DLPFC and right VLPFC activity with intensified stimulation improves LTS symptoms and treatment-related variables. For LTS symptoms, DLPFC stimulation was more efficient than VLPFC stimulation., For the other variables, no significant difference was observed between these two stimulation groups. These promising results require replication in larger trials.
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Affiliation(s)
- Jaber Alizadehgoradel
- Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran.
| | | | - Zahra Shirani
- Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran
| | - Mobina Barati
- Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran
| | - Mina Taherifard
- Department of Psychology, Mohaghegh-Ardabili University, Ardabil, Iran
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Germany; German Centre for Mental Health (DZPG), Germany
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Nejati V, Peyvandi A. The impact of time perception remediation on cold and hot executive functions and behavioral symptoms in children with ADHD. Child Neuropsychol 2024; 30:636-651. [PMID: 37646622 DOI: 10.1080/09297049.2023.2252962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
Children with ADHD struggle with impaired time management, indicating premature and temporally inadequate behavioral style. This study aimed to evaluate the impact of time perception remediation on hot and cold executive functions (EFs) and behavioral symptoms in children with ADHD. In this pilot study, an RCT design was employed to investigate the effects of the intervention on children with ADHD. The participants were assigned to either the control group (n = 15) or the intervention group (n = 13). The intervention group receive 10-12 sessions of program for attentive remediation of time perception (PART). Time perception, N-back, Wisconsin card sorting, Go/No-Go, balloon analog risk, Iowa gambling tasks, and Conner's parental rating scale were used for the assessment in three baseline, post-intervention, and follow-up sessions. Repeated measures ANOVAs were used for analysis. The results suggest improved time perception and risky decision making in intervention group. Working memory, inhibitory control, and cognitive flexibility did not improve after intervention. The behavioral symptoms ameliorated after intervention. Time perception is trainable in children with ADHD. This training effect transfers to hot EFs and behavioral symptoms, but not cold EFs. A cognitive model has been proposed based on the results of this studies and other cognitive training studies.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Aida Peyvandi
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
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Nejati V, Dehghan M, Shahidi S, Estaji R, Nitsche MA. Transcranial random noise stimulation (tRNS) improves hot and cold executive functions in children with attention deficit-hyperactivity disorder (ADHD). Sci Rep 2024; 14:7600. [PMID: 38556535 PMCID: PMC10982302 DOI: 10.1038/s41598-024-57920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
Children with attention deficit-hyperactivity disorder (ADHD) have impaired hot and cold executive functions, which is thought to be related to impaired ventromedial and dorsolateral prefrontal cortex (vmPFC and dlPFC) functions. The present study aimed to assess the impact concurrent stimulation of dlPFC and vmPFC through transcranial random noise stimulation (tRNS), a non-invasive brain stimulation tool which enhances cortical excitability via application of alternating sinusoidal currents with random frequencies and amplitudes over the respective target regions on hot and cold executive functions. Eighteen children with ADHD received real and sham tRNS over the left dlPFC and the right vmPFC in two sessions with one week interval. The participants performed Circle Tracing, Go/No-Go, Wisconsin Card Sorting, and Balloon Analogue Risk Tasks during stimulation in each session. The results showed improved ongoing inhibition, prepotent inhibition, working memory, and decision making, but not set-shifting performance, during real, as compared to sham stimulation. This indicates that simultaneous stimulation of the dlPFC and the vmPFC improves hot and cold executive functions in children with ADHD.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University Tehran, P.O. Box: 1983969411, Tehran, Iran.
| | - Mahshid Dehghan
- Department of Psychology, Shahid Beheshti University Tehran, P.O. Box: 1983969411, Tehran, Iran
| | - Shahriar Shahidi
- Department of Psychology, Shahid Beheshti University Tehran, P.O. Box: 1983969411, Tehran, Iran
| | - Reza Estaji
- Department of Psychology, Shahid Beheshti University Tehran, P.O. Box: 1983969411, Tehran, Iran
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
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11
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Salehinejad MA, Siniatchkin M. Safety of noninvasive brain stimulation in children. Curr Opin Psychiatry 2024; 37:78-86. [PMID: 38226535 DOI: 10.1097/yco.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
PURPOSE OF REVIEW Noninvasive brain stimulation (NIBS) is a promising method for altering cortical excitability with clinical implications. It has been increasingly used in children, especially in neurodevelopmental disorders. Yet, its safety and applications in the developing brain require further investigation. This review aims to provide an overview of the safety of commonly used NIBS techniques in children, including transcranial electrical stimulation (tES) and transcranial magnetic stimulation (TMS). Safety data for other NIBS methods is not reported in this review. RECENT FINDINGS In line with studies from the last decade, findings in the last 2 years (2022-2023) support the safety of NIBS in children and adolescents within the currently applied protocols. Both tES and TMS are well tolerated, if safety rules, including exclusion criteria, are applied. SUMMARY We briefly discussed developmental aspects of stimulation parameters that need to be considered in the developing brain and provided an up-to-date overview of tES/TMS applications in children and adolescents. Overall, the safety profile of tES/TMS in children is good. For both the tES and TMS applications, epilepsy and active seizure disorder should be exclusion criteria to prevent potential seizures. Using child-sized earplugs is required for TMS applications. We lack large randomized double-blind trialsand longitudinal studies to establish the safety of NIBS in children. VIDEO ABSTRACT http://links.lww.com/YCO/A78 .
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Affiliation(s)
- Mohammad Ali Salehinejad
- Neuromdulation Group, Department of Psychology and Neurosciences, Leibniz-Institut für Arbeitsforschung an der TU Dortmund, Dortmund
| | - Michael Siniatchkin
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany
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12
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Alizadehgoradel J, Pouresmali A, Taherifard M. Safety and Efficacy of an Intensified and Repeated Transcranial Direct Current Stimulation Targeting Supplementary Motor Area and Dorsolateral Prefrontal Cortex in Trichotillomania (Hair Pulling Disorder): A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2024; 22:188-193. [PMID: 38247425 PMCID: PMC10811400 DOI: 10.9758/cpn.23.1082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 01/23/2024]
Abstract
Trichotillomania (or hair pulling disorder) is a habitual condition in which patients constantly pull their hair. Although psychotherapies such as behavioral therapy and pharmacotherapy have shown relative effectiveness for trichotillomania, some patients fail to respond to these interventions or show only partial responses. Recently, noninvasive brain stimulation techniques such as transcranial direct current stimulation have shown promise in the treatment of psychiatric disorders. We designed a new protocol that included intensified and repeated during 16 sessions, every other day, 2 sessions one day, current intensity of 2 mA for 20 minutes, which regions dorsolateral prefrontal cortex (DLPFC) and supplementary motor area (SMA): Anodal (F3) and cathodal (SMA) were selected as stimulation target areas. The results showed that after the electrical stimulation intervention and also in the follow-up phase, there was a significant improvement in hair pulling behavior and psychiatric evaluations such as depression and anxiety. Therefore, there are many hopes in the effectiveness of the protocol used (intensified and repeated DLPFC and SMA areas) in the treatment of trichotillomania disorder, although there is a need for a future experimental study with a larger group of patients.
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Affiliation(s)
| | - Asghar Pouresmali
- Department of Family Health, Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mina Taherifard
- Department of Psychology, Mohaghegh-Ardabili University, Ardabil, Iran
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13
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Alizadehgoradel J, Molaei B, Barzegar Jalali K, Pouresmali A, Sharifi K, Hallajian AH, Nejati V, Glinski B, Vicario CM, Nitsche MA, Salehinejad MA. Targeting the prefrontal-supplementary motor network in obsessive-compulsive disorder with intensified electrical stimulation in two dosages: a randomized, controlled trial. Transl Psychiatry 2024; 14:78. [PMID: 38316750 PMCID: PMC10844238 DOI: 10.1038/s41398-024-02736-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Obsessive-compulsive disorder (OCD) is associated with a high disease burden, and treatment options are limited. We used intensified electrical stimulation in two dosages to target a main circuitry associated with the pathophysiology of OCD, left dorsolateral prefrontal cortex (l-DLPFC), and pre-supplementary motor area (pre-SMA) and assessed clinical outcomes, neuropsychological performance, and brain physiology. In a double-blind, randomized controlled trial, thirty-nine patients with OCD were randomly assigned to three groups of sham, 2-mA, or 1-mA transcranial direct current stimulation (tDCS) targeting the l-DLPFC (F3) and pre-SMA (FC2) with anodal and cathodal stimulation respectively. The treatment included 10 sessions of 20-minute stimulation delivered twice per day with 20-min between-session intervals. Outcome measures were reduction in OCD symptoms, anxiety, and depressive states, performance on a neuropsychological test battery (response inhibition, working memory, attention), oscillatory brain activities, and functional connectivity. All outcome measures except EEG were examined at pre-intervention, post-intervention, and 1-month follow-up times. The 2-mA protocol significantly reduced OCD symptoms, anxiety, and depression states and improved quality of life after the intervention up to 1-month follow-up compared to the sham group, while the 1-mA protocol reduced OCD symptoms only in the follow-up and depressive state immediately after and 1-month following the intervention. Both protocols partially improved response inhibition, and the 2-mA protocol reduced attention bias to OCD-related stimuli and improved reaction time in working memory performance. Both protocols increased alpha oscillatory power, and the 2-mA protocol decreased delta power as well. Both protocols increased connectivity in higher frequency bands at frontal-central areas compared to the sham. Modulation of the prefrontal-supplementary motor network with intensified tDCS ameliorates OCD clinical symptoms and results in beneficial cognitive effects. The 2-mA intensified stimulation resulted in larger symptom reduction and improved more converging outcome variables related to therapeutic efficacy. These results support applying the intensified prefrontal-SMA tDCS in larger trials.
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Affiliation(s)
| | - Behnam Molaei
- Department of Psychiatry and Psychology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
| | | | - Asghar Pouresmali
- Department of Family Health, Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Kiomars Sharifi
- Sharif Brain Center, Department of Electrical Engineering, Sharif University of Technology, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences, Tehran, Iran
| | | | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Benedikt Glinski
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Carmelo M Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Università di Messina, Messina, Italy
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Bielefeld, Germany
- German Centre for Mental Health (DZPG), Bochum, Germany
| | - Mohammad Ali Salehinejad
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences, Tehran, Iran.
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
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14
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Mauche N, Ulke C, Huang J, Franke A, Bogatsch H, Ethofer T, Grimm O, Frodl T, Hoffmann K, Juckel G, Kittel-Schneider S, Mehren A, Philipsen A, Plewnia C, Reif A, Ziegler GC, Strauß M. Treatment of adult attention-deficit hyperactivity disorder (ADHD) with transcranial direct current stimulation (tDCS): study protocol for a parallel, randomized, double-blinded, sham-controlled, multicenter trial (Stim-ADHD). Eur Arch Psychiatry Clin Neurosci 2024; 274:71-82. [PMID: 37479914 PMCID: PMC10786982 DOI: 10.1007/s00406-023-01652-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation treatment used as an alternative or complementary treatment for various neuropsychiatric disorders, and could be an alternative or add-on therapy to psychostimulants in attention-deficit hyperactivity disorder (ADHD). Previous studies provided some evidence for improvements in cognition and clinical symptoms in pediatric and adult ADHD patients. However, data from multi-center randomized controlled trials (RCTs) for this condition are lacking. Thus, our aim is to evaluate short- and mid-term effects of tDCS in this multi-center, randomized, double blind, and sham-controlled, parallel group clinical trial with a 1:1 randomization ratio. Primary endpoint is the total score of DSM-IV scale of the internationally established Conners' Adult ADHD Rating Scales (German self-report screening version, CAARS-S-SR), at day 14 post-intervention (p.i.) to detect short-term lasting effects analyzed via analyses of covariance (ANCOVAs). In case of significant between-groups differences at day 14 p.i., hierarchically ordered hypotheses on mid-term lasting effects will be investigated by linear mixed models with visit (5 time points), treatment, treatment by visit interaction, and covariates as fixed categorical effects plus a patient-specific visit random effect, using an unstructured covariance structure to model the residual within-patient errors. Positive results of this clinical trial will expand the treatment options for adult ADHD patients with tDCS and provide an alternative or add-on therapy to psychostimulants with a low risk for side effects.Trial Registration The trial was registered on July 29, 2022 in the German Clinical Trials Register (DRKS00028148).
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Affiliation(s)
- Nicole Mauche
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Christine Ulke
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Leipzig, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, University of Leipzig Medical Center, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany
| | - Jue Huang
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Annegret Franke
- Clinical Trial Centre Leipzig, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Holger Bogatsch
- Clinical Trial Centre Leipzig, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Thomas Ethofer
- Department of Psychiatry and Psychotherapy, LEAD Graduate School and Research Network, University Hospital of Tübingen, Tübingen, Germany
- Department of Biomedical Magnetic Resonance, University Hospital of Tübingen, Tübingen, Germany
| | - Oliver Grimm
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Frodl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Knut Hoffmann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Medicine Ruhr University, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Medicine Ruhr University, Bochum, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital, University of Wurzburg, Würzburg, Germany
| | - Aylin Mehren
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, LEAD Graduate School and Research Network, University Hospital of Tübingen, Tübingen, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Georg C Ziegler
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital, University of Wurzburg, Würzburg, Germany
| | - Maria Strauß
- Department of Psychiatry and Psychotherapy, University Hospital, University of Leipzig Medical Center, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany.
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15
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Kannen K, Rasbach J, Fantazi A, Wiebe A, Selaskowski B, Asché L, Aslan B, Lux S, Herrmann CS, Philipsen A, Braun N. Alpha modulation via transcranial alternating current stimulation in adults with attention-deficit hyperactivity disorder. Front Psychol 2024; 14:1280397. [PMID: 38282845 PMCID: PMC10812111 DOI: 10.3389/fpsyg.2023.1280397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/23/2023] [Indexed: 01/30/2024] Open
Abstract
Background One potential therapy treating attention-deficit/hyperactivity disorder (ADHD) is to modulate dysfunctional brain activations using brain stimulation techniques. While the number of studies investigating the effect of transcranial direct current stimulation on ADHD symptoms continues to increase, transcranial alternating current stimulation (tACS) is poorly examined. Previous studies reported impaired alpha brain oscillation (8-12 Hz) that may be associated with increased attention deficits in ADHD. Our aim was to enhance alpha power in adult ADHD patients via tACS, using different methods to explore potential therapeutic effects. Methods Undergoing a crossover design, adults with ADHD received active and sham stimulation on distinct days. Before and after each intervention, mean alpha power, attention performance, subjective symptom ratings, as well as head and gaze movement were examined. Results Frequency analyses revealed a significant power increase in the alpha band after both interventions. Despite a trend toward an interaction effect, this alpha power increase was, however, not significantly higher after active stimulation compared to sham stimulation. For the other measures, some additional pre-post effects were found, which were not intervention-related. Conclusion Our study cannot provide clear evidence for a tACS-induced increase in alpha power in adult ADHD patients, and thus no stimulation related improvement of attention parameters. We provide further recommendations for the future investigation of tACS as a potential ADHD treatment.
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Affiliation(s)
- Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Johanna Rasbach
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Amin Fantazi
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Behrem Aslan
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Christoph S. Herrmann
- Experimental Psychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
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16
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Guimarães RSQ, Bandeira ID, Barretto BL, Wanke T, Alves COC, Barretto TL, de Carvalho CF, Dorea-Bandeira I, Tolentino A, Lins-Silva DH, Lucena PH, Lucena R. Efficacy and safety of transcranial direct current stimulation over the left dorsolateral prefrontal cortex in children and adolescents with attention-deficit/hyperactivity disorder: a randomized, triple-blinded, sham-controlled, crossover trial. Front Psychiatry 2024; 14:1217407. [PMID: 38268562 PMCID: PMC10806216 DOI: 10.3389/fpsyt.2023.1217407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Although pharmacological treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) has demonstrated efficacy, several individuals persist in experiencing social and academic impairment. Additionally, the occurrence of significant side effects may render the use of psychotropic medications untenable. However, Transcranial Direct Current Stimulation (tDCS), a non-invasive brain stimulation technique, shows promising results in treating ADHD. Objectives To investigate the efficacy and safety of tDCS on the performance of children and adolescents with ADHD in neuropsychological tests involving visual attention, visual and verbal working memory, and inhibitory control. Methodology This study was a triple-blind, randomized, sham-controlled, crossover clinical trial. The intervention consisted of a daily session of tDCS (2 mA) or sham targeting the left dorsolateral prefrontal cortex (L-DLPFC), for 30 min, on five consecutive days. The primary outcome was change in the Visual Attention Test, Fourth Edition (TAVIS-4) before and after each intervention. Subjects were also evaluated pre and post-tDCS using the Digit Span subtest of the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V), the Developmental Neuropsychological Assessment, Second Edition (NEPSY-II) Inhibiting Response (IR) subtest, and the Corsi Block-Tapping Task. Results Fifteen individuals were included, and no statistically significant difference was observed when comparing the results of the TAVIS-4, the IR of NEPSY-II, and the intragroup Digit Span subtest of WISC-V undertaken before and after the procedure. Adverse events were mainly self-limiting and transient. The participants did not perceive any benefit from tDCS when measured on the Patient Global Impression of Improvement (PGI-I) Scale. Conclusion This study did not meet its primary endpoint and found no performance enhancement in any investigated neuropsychological outcomes relating to the intervention group.
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Affiliation(s)
| | - Igor D. Bandeira
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | | | - Thamires Wanke
- Instituto de Psicologia, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | | | | | - Arthur Tolentino
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Pedro H. Lucena
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Rita Lucena
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
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Nejati V, Khoshroo S, Mirikaram F. Review of spatial disability in individuals with attention deficit-hyperactivity disorder: Toward spatial cognition theory. Clin Child Psychol Psychiatry 2024; 29:312-337. [PMID: 37192629 DOI: 10.1177/13591045231176707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Spatial cognition is the ability to detect, process, integrate, and formulate the spatial aspects of the environment. Spatial abilities, as perceptual doorway of information processing, influence on higher cognitive functions. This systematic review aimed to explore impaired spatial ability in individuals with Attention Deficit-Hyperactivity Disorders (ADHD). The data from 18 empirical experiments that explored at least one factor of spatial ability in individuals with ADHD was collected in accordance with the PRISMA approach. This study discussed several determinants of impaired spatial ability, including factors, domains, tasks, and measures of spatial ability. Furthermore, the impact of age, gender, and comorbidities are discussed. Finally, a model was proposed to explain the impaired cognitive functions in children with ADHD based on spatial abilities.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Saba Khoshroo
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
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18
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Vöckel J, Spitznagel N, Markser A, Sigrist C, Koenig J. A paucity of evidence in youth: The curious case of transcranial direct current stimulation for depression. Asian J Psychiatr 2024; 91:103838. [PMID: 38000172 DOI: 10.1016/j.ajp.2023.103838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/10/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
A significant proportion of youth with depression do not respond to available treatment. Transcranial direct current stimulation (tDCS) is a promising third-line treatment in depressed adults, but evidence in youth seems scarce. Following the PRISMA guidelines, we conducted a systematic literature review on tDCS treatment for depression in children and adolescents. No published studies were found on the use of tDCS in youth with depression. Given the null-findings, no conclusion can be drawn about the effectiveness of tDCS treatment for adolescent depression. The reasons for this paucity of evidence in light of existing regulatory frameworks and technical challenges are discussed.
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Affiliation(s)
- Jasper Vöckel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany.
| | - Nele Spitznagel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Anna Markser
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Christine Sigrist
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
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Zhang DW, Johnstone SJ, Sauce B, Arns M, Sun L, Jiang H. Remote neurocognitive interventions for attention-deficit/hyperactivity disorder - Opportunities and challenges. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110802. [PMID: 37257770 DOI: 10.1016/j.pnpbp.2023.110802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
Improving neurocognitive functions through remote interventions has been a promising approach to developing new treatments for attention-deficit/hyperactivity disorder (AD/HD). Remote neurocognitive interventions may address the shortcomings of the current prevailing pharmacological therapies for AD/HD, e.g., side effects and access barriers. Here we review the current options for remote neurocognitive interventions to reduce AD/HD symptoms, including cognitive training, EEG neurofeedback training, transcranial electrical stimulation, and external cranial nerve stimulation. We begin with an overview of the neurocognitive deficits in AD/HD to identify the targets for developing interventions. The role of neuroplasticity in each intervention is then highlighted due to its essential role in facilitating neuropsychological adaptations. Following this, each intervention type is discussed in terms of the critical details of the intervention protocols, the role of neuroplasticity, and the available evidence. Finally, we offer suggestions for future directions in terms of optimizing the existing intervention protocols and developing novel protocols.
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Affiliation(s)
- Da-Wei Zhang
- Department of Psychology/Center for Place-Based Education, Yangzhou University, Yangzhou, China; Department of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia.
| | - Stuart J Johnstone
- School of Psychology, University of Wollongong, Wollongong, Australia; Brain & Behaviour Research Institute, University of Wollongong, Australia
| | - Bruno Sauce
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, Netherlands; Department of Experimental Psychology, Utrecht University, Utrecht, Netherlands; NeuroCare Group, Nijmegen, Netherlands
| | - Li Sun
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China; National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Han Jiang
- College of Special Education, Zhejiang Normal University, Hangzhou, China
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20
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Yuan X, Zhong X, Wang C, Yang Y, Jiang C. Evaluation of Transcranial Direct Current Stimulation in Motor Function and Neural Rehabilitation. J ECT 2023; 39:235-241. [PMID: 36988514 DOI: 10.1097/yct.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
ABSTRACT Transcranial direct current stimulation (tDCS) is used in neuromodulation to regulate the excitability of the cerebral cortex and induce neural plasticity. It was initially used to rehabilitate patients with neurological diseases. However, with the increasing number of studies involving healthy individuals, this technology is currently used in the field of sports as well. The administration of tDCS to the cerebral cortex, especially over the primary motor cortex (M1), has been found to improve muscle strength, enhance endurance, and promote motor skills in humans. This study mainly summarizes the effects of tDCS on motor function, mainly involving motor promotion of tDCS in healthy athletes and nonathletes, and in patients diagnosed with neurological diseases. The tDCS is a promising and effective tool used to promote motor function by regulating cortical excitability. However, no consensus is available regarding individually appropriate models of tDCS.
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Affiliation(s)
| | | | | | - Yuan Yang
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
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21
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Nejati V, Famininejad Z, Rad JA. Neural symphony of risky decision making in children with ADHD: Insights from transcranial alternating current stimulation and cognitive modeling. Neurophysiol Clin 2023; 53:102898. [PMID: 37659136 DOI: 10.1016/j.neucli.2023.102898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND The ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) are key brain regions involved in risky decision making, affected in individuals with attention deficit hyperactivity disorder (ADHD). This study aims to examine how entrainment of these areas impacts the process and outcome of risky decision making in children with ADHD. METHODS Eighteen children with ADHD performed the balloon analogue risk-taking task (BART) during five different sessions of tACS (1.5 mA, 6 Hz), separated by one-week intervals, via (1) two channels with synchronized stimulation over the left dlPFC and right vmPFC, (2) the same electrode placement with anti-phase stimulation, (3) stimulation over the left dlPFC only, (4) stimulation over right vmPFC only, and (5) sham stimulation. Four-parameter and constant-sensitivity models were used to model the data. RESULTS The study showed that synchronized stimulation was associated with a reduction in positive prior belief, risk propensity, and deterministic selection. Desynchronized stimulation was associated with accelerated learning from initial selections. Isolated stimulation of the dlPFC leads to riskier decision enhanced learning updates and risk propensity, whereas isolated stimulation of the vmPFC facilitated faster learning and increased probabilistic selection. CONCLUSION The results highlight the important roles of the dlPFC and vmPFC and their communication in decision making, showcasing their impact on various aspects of the decision-making process. The findings provide valuable insights into the complex interplay between cognitive and emotional factors in shaping our choices.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran.
| | | | - Jamal Amani Rad
- Department of Cognitive Modeling, Institute of Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
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22
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Nejati V, Estaji R, Helisaz Z. Transcranial Direct-Current Stimulation Improves Verbal Fluency in Children with Attention Deficit Hyperactivity Disorder (ADHD). Brain Sci 2023; 13:1257. [PMID: 37759858 PMCID: PMC10526326 DOI: 10.3390/brainsci13091257] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Individuals with attention deficit hyperactivity disorder (ADHD) struggle with impaired verbal fluency as an executive function. The left and right dorsolateral prefrontal cortex (dlPFC) and the right inferior frontal gurus (IFG), which show reduced functionality in individuals with ADHD, are involved in verbal fluency. In this study, a total of thirty-seven children with ADHD participated in two separate experiments. Each experiment included three different stimulation conditions: anodal left dlPFC/cathodal right vmPFC stimulation, the reversed montage, and a sham stimulation in Experiment 1, and anodal right dlPFC, anodal right IFG with extracranial return electrode, and a sham stimulation in Experiment 2. During each session, participants performed semantic and phonemic verbal fluency tasks while receiving tDCS. The results revealed a significant main effect of stimulation condition on phonemic verbal fluency during anodal left dlPFC stimulation in Experiment 1, and on semantic verbal fluency during both real stimulation conditions in Experiment 2. In conclusion, this study suggests that anodal left dlPFC stimulation improves phonemic verbal fluency, while anodal right dlPFC and right IFG stimulation enhance semantic verbal fluency. This domain-specific improvement can be attributed to the distinct cognitive demands of phonemic and semantic verbal fluency tasks. Phonemic verbal fluency heavily relies on working memory processes, whereas semantic verbal fluency requires effective inhibitory control and cognitive flexibility.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran P.O. Box 1983969411, Iran
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23
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Tortora F, Hadipour AL, Battaglia S, Falzone A, Avenanti A, Vicario CM. The Role of Serotonin in Fear Learning and Memory: A Systematic Review of Human Studies. Brain Sci 2023; 13:1197. [PMID: 37626553 PMCID: PMC10452575 DOI: 10.3390/brainsci13081197] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Fear is characterized by distinct behavioral and physiological responses that are essential for the survival of the human species. Fear conditioning (FC) serves as a valuable model for studying the acquisition, extinction, and expression of fear. The serotonin (5-hydroxytryptamine, 5-HT) system is known to play a significant role in emotional and motivational aspects of human behavior, including fear learning and expression. Accumulating evidence from both animal and human studies suggests that brain regions involved in FC, such as the amygdala, hippocampus, and prefrontal cortex, possess a high density of 5-HT receptors, implicating the crucial involvement of serotonin in aversive learning. Additionally, studies exploring serotonin gene polymorphisms have indicated their potential influence on FC. Therefore, the objective of this work was to review the existing evidence linking 5-HT with fear learning and memory in humans. Through a comprehensive screening of the PubMed and Web of Science databases, 29 relevant studies were included in the final review. These studies investigated the relationship between serotonin and fear learning using drug manipulations or by studying 5-HT-related gene polymorphisms. The results suggest that elevated levels of 5-HT enhance aversive learning, indicating that the modulation of serotonin 5-HT2A receptors regulates the expression of fear responses in humans. Understanding the role of this neurochemical messenger in associative aversive learning can provide insights into psychiatric disorders such as anxiety and post-traumatic stress disorder (PTSD), among others.
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Affiliation(s)
- Francesco Tortora
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, Via Concezione 6, 98121 Messina, Italy; (F.T.); (A.F.)
| | - Abed L. Hadipour
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, Via Concezione 6, 98121 Messina, Italy; (F.T.); (A.F.)
| | - Simone Battaglia
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia “Renzo Canestrari”, Campus di Cesena, Alma Mater Studiorum Università di Bologna, Viale Rasi e Spinelli 176, 47521 Cesena, Italy;
| | - Alessandra Falzone
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, Via Concezione 6, 98121 Messina, Italy; (F.T.); (A.F.)
| | - Alessio Avenanti
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia “Renzo Canestrari”, Campus di Cesena, Alma Mater Studiorum Università di Bologna, Viale Rasi e Spinelli 176, 47521 Cesena, Italy;
- Centro de Investigación en Neuropsicología y Neurociencias Cognitivas, Universidad Católica Del Maule, Talca 3460000, Chile
| | - Carmelo M. Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, Via Concezione 6, 98121 Messina, Italy; (F.T.); (A.F.)
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Dakwar-Kawar O, Mairon N, Hochman S, Berger I, Cohen Kadosh R, Nahum M. Transcranial random noise stimulation combined with cognitive training for treating ADHD: a randomized, sham-controlled clinical trial. Transl Psychiatry 2023; 13:271. [PMID: 37528107 PMCID: PMC10394047 DOI: 10.1038/s41398-023-02547-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
Non-invasive brain stimulation has been suggested as a potential treatment for improving symptomology and cognitive deficits in Attention-Deficit/Hyperactivity Disorder (ADHD), the most common childhood neurodevelopmental disorder. Here, we examined whether a novel form of stimulation, high-frequency transcranial random noise stimulation (tRNS), applied with cognitive training (CT), may impact symptoms and neural oscillations in children with ADHD. We conducted a randomized, double-blind, sham-controlled trial in 23 unmedicated children with ADHD, who received either tRNS over the right inferior frontal gyrus (rIFG) and left dorsolateral prefrontal cortex (lDLPFC) or sham stimulation for 2 weeks, combined with CT. tRNS + CT yielded significant clinical improvements (reduced parent-reported ADHD rating-scale scores) following treatment, compared to the control intervention. These improvements did not change significantly at a 3-week follow-up. Moreover, resting state (RS)-EEG periodic beta bandwidth of the extracted peaks was reduced in the experimental compared to control group immediately following treatment, with further reduction at follow-up. A lower aperiodic exponent, which reflects a higher cortical excitation/inhibition (E/I) balance and has been related to cognitive improvement, was seen in the experimental compared to control group. This replicates previous tRNS findings in adults without ADHD but was significant only when using a directional hypothesis. The experimental group further exhibited longer sleep onset latencies and more wake-up times following treatment compared to the control group. No significant group differences were seen in executive functions, nor in reported adverse events. We conclude that tRNS + CT has a lasting clinical effect on ADHD symptoms and on beta activity. These results provide a preliminary direction towards a novel intervention in pediatric ADHD.
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Affiliation(s)
- Ornella Dakwar-Kawar
- School of Occupational Therapy, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noam Mairon
- School of Occupational Therapy, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Itai Berger
- Pediatric Neurology Unit, Assuta-Ashdod University Hospital and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Mor Nahum
- School of Occupational Therapy, Hebrew University of Jerusalem, Jerusalem, Israel.
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25
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D’Aiello B, Lazzaro G, Battisti A, Pani P, Di Vara S, De Rossi P, Pretelli I, Costanzo F, Vicari S, Menghini D. Methylphenidate is more effective to improve inhibitory control and working memory compared to tDCS in children and adolescents with attention deficit/hyperactivity disorder: a proof-of-concept study. Front Neurosci 2023; 17:1170090. [PMID: 37483344 PMCID: PMC10360130 DOI: 10.3389/fnins.2023.1170090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Attention-deficit/hyperactivity disorder (ADHD) is characterized by an inappropriate, pervasive and persistent pattern of inattention, hyperactivity, and/or impulsivity and associated with substantial functional impairment. Despite considerable advances in the understanding and management of ADHD, some patients do not respond well to methylphenidate (MPH), the first-choice pharmacological treatment. Over the past decades, among non-invasive brain stimulation techniques, transcranial direct current stimulation (tDCS) has proven to be an effective and safe technique to improve behavior and cognition in children with neurodevelopmental disorders, including ADHD, by modifying cortical excitability. However, the effect of tDCS has never been directly compared with that of the MPH. The present randomized sham-controlled trial evaluated the effect of a single session of anodal tDCS compared with the administration of a single dose of MPH in children and adolescents with ADHD. Methods After completing baseline assessment (T0), 26 children and adolescents with ADHD were exposed to 3 conditions with a 24-h interval-sessions: (A) a single session of anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC); (B) a single session of sham tDCS over the left DLPFC; (C) a single dose of MPH. Results Our results showed that after administering a single dose of MPH, children and adolescents with ADHD improved inhibitory control and visual-spatial WM compared with baseline, anodal, and sham tDCS. However, a single session of active tDCS over the left DLPFC was not effective compared with either baseline or sham tDCS. Discussion In conclusion, our protocol in ADHD involving a single tDCS session did not demonstrate consistent improvements in neurocognitive features compared with baseline, sham tDCS, or single MPH administration. Different protocols need to be developed to further test the effectiveness of tDCS in improving ADHD symptoms.
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Affiliation(s)
- Barbara D’Aiello
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Human Science, LUMSA University, Rome, Italy
| | - Giulia Lazzaro
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Andrea Battisti
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Human Science, LUMSA University, Rome, Italy
| | - Pierpaolo Pani
- Department of Physiology and Pharmacology, Sapienza University, Rome, Italy
| | - Silvia Di Vara
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Pietro De Rossi
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Italo Pretelli
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Floriana Costanzo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Deny Menghini
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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26
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Anoushiravani S, Alizadehgoradel J, Iranpour A, Yousefi Bilehsavar O, Pouresmali A, Nitsche MA, Salehinejad MA, Mosayebi-Samani M, Zoghi M. The impact of bilateral anodal transcranial direct current stimulation of the premotor and cerebellar cortices on physiological and performance parameters of gymnastic athletes: a randomized, cross-over, sham-controlled study. Sci Rep 2023; 13:10611. [PMID: 37391555 PMCID: PMC10313825 DOI: 10.1038/s41598-023-37843-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/28/2023] [Indexed: 07/02/2023] Open
Abstract
Professional sports performance relies critically on the interaction between the brain and muscles during movement. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique which modulates cortical excitability and can be used to improve motor performance in athletes. The present study aimed to investigate the effect of bilateral anodal tDCS (2 mA, 20 min) over the premotor cortex or cerebellum on motor and physiological functions and peak performance of professional gymnastics athletes. Seventeen professional gymnastics athletes participated in a randomized, sham-controlled, crossover study. In this study, we assessed the efficacy of two anodal tDCS protocols (2 mA, 20 min) with stimulation over the bilateral premotor cortex or cerebellum with the return electrodes placed over the opposite supraorbital areas. Power speed, strength coordination, endurance, static and dynamic strength, static and dynamic flexibility, and rating of perceived exertion were measured before and immediately after tDCS interventions (bilateral anodal tDCS over premotor cortices, anodal tDCS over the cerebellum, and sham tDCS). Additionally, physiological muscle performance parameters, including maximum voluntary isometric contraction (MVIC) of upper body muscles, were assessed during tDCS. Bilateral anodal tDCS over the premotor cortex, compared to anodal tDCS over the cerebellum and sham tDCS conditions, significantly improved power speed, strength coordination, and static and dynamic strength variables of professional gymnastics athletes. Furthermore, bilateral anodal tDCS over the cerebellum, compared to sham tDCS, significantly improved strength coordination. Moreover, bilateral premotor anodal tDCS significantly increased MVIC of all upper body muscles during stimulation, while anodal tDCS over the cerebellum increased MVIC in only some muscles. Bilateral anodal tDCS over the premotor cortex, and to a minor degree over the cerebellum, might be suited to improve some aspects of motor and physiological functions and peak performance levels of professional gymnastics athletes.Clinical Trial Registration ID: IRCT20180724040579N2.
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Affiliation(s)
- Sajjad Anoushiravani
- Department of Sports Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Jaber Alizadehgoradel
- Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran.
| | - Asgar Iranpour
- Department of Sports Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Omid Yousefi Bilehsavar
- Department of Sports Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Asghar Pouresmali
- Department of Family Health, Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Mohsen Mosayebi-Samani
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Maryam Zoghi
- Discipline of Physiotherapy, Institute of Health and Wellbeing, Federation University, Victoria, Australia
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27
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Buchanan DM, Amare S, Gaumond G, D'Angiulli A, Robaey P. Safety and Tolerability of tDCS across Different Ages, Sexes, Diagnoses, and Amperages: A Randomized Double-Blind Controlled Study. J Clin Med 2023; 12:4346. [PMID: 37445385 DOI: 10.3390/jcm12134346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique with substantial evidence for its safety and tolerability in adults. However, less than 5% of published tDCS research is in pediatrics. Our primary objective was to investigate tDCS safety, tolerability, and acceptability in a sample of children and adults. We hypothesized that children and adults would be equal with regard to tDCS safety, tolerability, and acceptability. We tested this hypothesis using a Bayesian approach. Sixty participants aged 6-45 (balanced for sex) participated in a randomized double-blind controlled trial. They were randomly assigned to two ten-minute tDCS sessions with varying amperages and electrode locations. The primary outcome measure of this study was the intensity of 13 potential side effects evaluated at six different time points spanning two weeks. Independent sample Bayes factor tests were conducted between children/adults, males/females, clinical/healthy, and low/high amperage groups. As predicted, there was moderate support for the null hypothesis in all between-group analyses. There were no serious adverse events or dropouts, and the number needed to treat for an additional harmful outcome was 23. This study provided evidence supporting the overall short-term safety, tolerability, and acceptability of tDCS including amperages up to 2 mA and different electrode placements.
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Affiliation(s)
- Derrick M Buchanan
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada
- Neuroscience of Imagination Cognition Emotion Research Lab, Carleton University, Ottawa, ON K1S 5B6, Canada
- Neuropsychiatric Lab, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Sarah Amare
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada
- Neuroscience of Imagination Cognition Emotion Research Lab, Carleton University, Ottawa, ON K1S 5B6, Canada
- Neuropsychiatric Lab, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Genevieve Gaumond
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada
- Neuroscience of Imagination Cognition Emotion Research Lab, Carleton University, Ottawa, ON K1S 5B6, Canada
- Neuropsychiatric Lab, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Amedeo D'Angiulli
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada
- Neuroscience of Imagination Cognition Emotion Research Lab, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Philippe Robaey
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada
- Neuropsychiatric Lab, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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28
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Nejati V, Mirikaram F, Rad JA. Transcranial direct current stimulation alters the process of reward processing in children with ADHD: Evidence from cognitive modeling. Neurophysiol Clin 2023; 53:102884. [PMID: 37224617 DOI: 10.1016/j.neucli.2023.102884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND The ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) are the neural underpinnings of reward processing, which is impaired in individuals with attention deficit hyperactivity disorder (ADHD). In the present study, we aimed to explore the impact of the vmPFC and the dlPFC regulation on reward processing. METHODS Twenty-six children with ADHD performed the balloon analogue risk-taking task (BART) and chocolate delay discounting task (CDDT) during five different sessions of transcranial direct current stimulation (tDCS), separated by a one-week interval: anodal left dlPFC/cathodal right vmPFC, the reversed electrode positioning, anodal left dlPFC stimulation with extracranial return electrode, anodal right vmPFC stimulation with extracranial return electrodes, and sham stimulation. Four-parameter and constant-sensitivity models were used to model the data. RESULTS In the BART, anodal dlPFC/cathodal vmPFC stimulation facilitated conservative decision making, anodal tDCS over dlPFC with extracranial return electrode increased positive beliefs about the explosion of a balloon, and anodal vmPFC/cathodal dlPFC stimulation reduced ongoing learning in the process of decision making. In the CDDT, anodal vmPFC stimulation with extracranial return electrode decreased impatience in the process of the task. CONCLUSION These results suggest a role of the left dlPFC and right vmPFC in the outcome of decision making and the process of risky decision making and delay discounting.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran.
| | - Fateme Mirikaram
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Jamal Amani Rad
- Department of Cognitive Modeling, Institute of Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
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29
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Casula A, Milazzo BM, Martino G, Sergi A, Lucifora C, Tomaiuolo F, Quartarone A, Nitsche MA, Vicario CM. Non-Invasive Brain Stimulation for the Modulation of Aggressive Behavior-A Systematic Review of Randomized Sham-Controlled Studies. Life (Basel) 2023; 13:life13051220. [PMID: 37240865 DOI: 10.3390/life13051220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
INTRO Aggressive behavior represents a significant public health issue, with relevant social, political, and security implications. Non-invasive brain stimulation (NIBS) techniques may modulate aggressive behavior through stimulation of the prefrontal cortex. AIMS To review research on the effectiveness of NIBS to alter aggression, discuss the main findings and potential limitations, consider the specifics of the techniques and protocols employed, and discuss clinical implications. METHODS A systematic review of the literature available in the PubMed database was carried out, and 17 randomized sham-controlled studies investigating the effectiveness of NIBS techniques on aggression were included. Exclusion criteria included reviews, meta-analyses, and articles not referring to the subject of interest or not addressing cognitive and emotional modulation aims. CONCLUSIONS The reviewed data provide promising evidence for the beneficial effects of tDCS, conventional rTMS, and cTBS on aggression in healthy adults, forensic, and clinical samples. The specific stimulation target is a key factor for the success of stimulation on aggression modulation. rTMS and cTBS showed opposite effects on aggression compared with tDCS. However, due to the heterogeneity of stimulation protocols, experimental designs, and samples, we cannot exclude other factors that may play a confounding role.
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Affiliation(s)
- Antony Casula
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, 98121 Messina, Italy
| | - Bianca M Milazzo
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, 98121 Messina, Italy
| | - Gabriella Martino
- Dipartimento di Medicina e Clinica Sperimentale, Università degli Studi di Messina, A.O.U. "G. Martino", Via Consolare Valeria, 98125 Messina, Italy
| | - Alessandro Sergi
- Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università degli Studi di Messina, Viale F. Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Chiara Lucifora
- Dipartimento di Filosofia e Comunicazione, Università di Bologna, 40131 Bologna, Italy
| | - Francesco Tomaiuolo
- Dipartimento di Medicina e Clinica Sperimentale, Università degli Studi di Messina, A.O.U. "G. Martino", Via Consolare Valeria, 98125 Messina, Italy
| | | | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, 44139 Dortmund, Germany
- University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital of Bethel Foundation, University Hospital OWL, Bielefeld University, 33615 Bielefeld, Germany
| | - Carmelo M Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, 98121 Messina, Italy
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30
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Transcranial Direct Current Stimulation (tDCS) in Pediatric Populations—– Voices from Typically Developing Children and Adolescents and their Parents. NEUROETHICS-NETH 2023. [DOI: 10.1007/s12152-022-09507-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Transcranial direct current stimulation (tDCS) is a brain stimulation technique currently being researched as an alternative or complimentary treatment for various neurological disorders. There is little knowledge about experiences of the participants of tDCS clinical research, especially from pediatric studies.
Methods
An interview study with typically developing minors (n = 19, mean age 13,66 years) participating in a tDCS study, and their parents (n = 18) was conducted to explore their views and experiences and inform the ethical analysis.
Results
Children (10–13 years old) and adolescents (14–18 years old) reported good experiences with the stimulation. Next to financial incentives, main motives to participate in the study were curiosity and the possibility to help develop treatments for children affected by neurological disorders. They could also see a potential of using tDCS in a non-medical setting, especially regarding the provision of equal opportunity, e.g. in education. Parents also presented a positive attitude towards tDCS and their children participation in the basic research study. Nevertheless, their understanding of tDCS was rather poor. Even though many of them understood the techniques, they often did not see the link between the (current) lack of side effects and an absence of longitudinal studies. Parents were also cautious about using tDCS for non-medical/enhancement purposes.
Conclusions
The study findings show a need for more transparent information about the state of the art of tDCS, its function and what it might be able to offer, especially considering the good acceptability of tDCS.
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Cheung T, Chau B, Fong KH, Lam JYT, Lo H, Li MH, Li AMMC, Beisteiner R, Lei S, Yee BK, Cheng CPW. Evaluating the efficacy and safety of transcranial pulse stimulation on adolescents with attention deficit hyperactivity disorder: Study protocol of a pilot randomized, double-blind, sham-controlled trial. Front Neurol 2023; 14:1076086. [PMID: 37056363 PMCID: PMC10086174 DOI: 10.3389/fneur.2023.1076086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundTraditional treatment alone might not effectively control the severity of attention deficit hyperactivity disorder (ADHD) symptoms. Transcranial pulse stimulation (TPS) is a non-invasive brain stimulation (NIBS) technology used on older adults with mild neurocognitive disorders and adults with major depressive disorder. However, there has been no study conducted on young adolescents with ADHD. This will be the first nationwide study evaluating the efficacy and safety of TPS in the treatment of ADHD among young adolescents in Hong Kong.MethodsThis study proposes a double-blinded, randomized, sham-controlled trial including TPS as an intervention group and a sham TPS group. Both groups will be measured at baseline (T1), immediately after the intervention (T2), and at the 1-month (T3) and 3-month follow-ups (T4).RecruitmentA total of 30 subjects aged between 12 and 17 years, diagnosed with attention deficit hyperactivity disorder (ADHD), will be recruited in this study. All subjects will be computer randomized into either the intervention group or the sham TPS group on a 1:1 ratio.InterventionAll subjects in each group will have to undertake functional MRI (fMRI) before and after six 30-min TPS sessions, which will be completed in 2 weeks' time.OutcomesBaseline measurements and post-TPS evaluation of the ADHD symptoms and executive functions will also be conducted on all participants. The 1- and 3-month follow-up periods will be used to assess the long-term sustainability of the TPS intervention. For statistical analysis, ANOVA with repeated measures will be used to analyze data. Missing data were managed by multiple imputations. The level of significance will be set to p < 0.05.Significance of the studyResults emerging from this study will generate new knowledge to ascertain whether TPS can be used as a top-on treatment for ADHD.Clinical trial registrationclinicaltrails.gov, identifier: NCT05422274.
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Affiliation(s)
- Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- The Mental Health Research Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- *Correspondence: Teris Cheung
| | - Bolton Chau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kwan Hin Fong
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Joyce Yuen Ting Lam
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Herman Lo
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Man Ho Li
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | | | | | - Sun Lei
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Benjamin K. Yee
- The Mental Health Research Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Calvin Pak Wing Cheng
- Department of Psychiatry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Calvin Pak Wing Cheng
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Basiri N, Hadianfard H. Adult ADHD Treatment Based on Combination of Dialectical Behavior Therapy (DBT) and Transcranial Direct Current Stimulation (tDCS) as Measured by Subjective and Objective Scales. J Atten Disord 2023; 27:57-66. [PMID: 36047471 DOI: 10.1177/10870547221118527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Almost 30% of ADHD adults do not respond to standard pharmaceuticals. Transcranial direct current stimulation (tDCS) is a method for modulation of cortical excitability. On the other hand, dialectical behavioral therapy (DBT) is a cognitive-behavioral approach that might be utilized for adults with ADHD. The effects of integration of these interventions are only beginning to be explored. In the present work, we used both subjective and objective measures to investigate the effects of tDCS, DBT, and the integration of the two in treating adult ADHD symptoms. A total of 80 adults with ADHD (63 females, 17 males) participated in the study and were grouped into control, DBT, tDCS, and combined groups. Based on the observed results, the combination of DBT and tDCS was significantly effective in improving the mentioned variables compared to administration of each method in isolation. The results are discussed in terms of neurophysiological and psychological aspects of treatment methods.
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Westwood SJ, Criaud M, Lam SL, Lukito S, Wallace-Hanlon S, Kowalczyk OS, Kostara A, Mathew J, Agbedjro D, Wexler BE, Cohen Kadosh R, Asherson P, Rubia K. Transcranial direct current stimulation (tDCS) combined with cognitive training in adolescent boys with ADHD: a double-blind, randomised, sham-controlled trial. Psychol Med 2023; 53:497-512. [PMID: 34225830 PMCID: PMC9899574 DOI: 10.1017/s0033291721001859] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/19/2021] [Accepted: 04/22/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) could be a side-effect-free alternative to psychostimulants in attention-deficit/hyperactivity disorder (ADHD). Although there is limited evidence for clinical and cognitive effects, most studies were small, single-session and stimulated left dorsolateral prefrontal cortex (dlPFC). No sham-controlled study has stimulated the right inferior frontal cortex (rIFC), which is the most consistently under-functioning region in ADHD, with multiple anodal-tDCS sessions combined with cognitive training (CT) to enhance effects. Thus, we investigated the clinical and cognitive effects of multi-session anodal-tDCS over rIFC combined with CT in double-blind, randomised, sham-controlled trial (RCT, ISRCTN48265228). METHODS Fifty boys with ADHD (10-18 years) received 15 weekday sessions of anodal- or sham-tDCS over rIFC combined with CT (20 min, 1 mA). ANCOVA, adjusting for baseline measures, age and medication status, tested group differences in clinical and ADHD-relevant executive functions at posttreatment and after 6 months. RESULTS ADHD-Rating Scale, Conners ADHD Index and adverse effects were significantly lower at post-treatment after sham relative to anodal tDCS. No other effects were significant. CONCLUSIONS This rigorous and largest RCT of tDCS in adolescent boys with ADHD found no evidence of improved ADHD symptoms or cognitive performance following multi-session anodal tDCS over rIFC combined with CT. These findings extend limited meta-analytic evidence of cognitive and clinical effects in ADHD after 1-5 tDCS sessions over mainly left dlPFC. Given that tDCS is commercially and clinically available, the findings are important as they suggest that rIFC stimulation may not be indicated as a neurotherapy for cognitive or clinical remediation for ADHD.
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Affiliation(s)
- Samuel J. Westwood
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | - Marion Criaud
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | - Sheut-Ling Lam
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | - Steve Lukito
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | | | - Olivia S. Kowalczyk
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
- Department of Neuroimaging, King's College London, London, UK
| | - Afroditi Kostara
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | - Joseph Mathew
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | | | - Bruce E. Wexler
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Roi Cohen Kadosh
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip Asherson
- Social Genetic & Developmental Psychiatry, King's College London, London, UK
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
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Vicario CM, Martino G. Psychology and technology: how Virtual Reality can boost psychotherapy and neurorehabilitation. AIMS Neurosci 2022; 9:454-459. [PMID: 36660073 PMCID: PMC9826745 DOI: 10.3934/neuroscience.2022025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- C. M. Vicario
- COSPECS Department, University of Messina, 98122 Messina, Italy,* Correspondence:
| | - G. Martino
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy,* Correspondence:
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Zemestani M, Hoseinpanahi O, Salehinejad MA, Nitsche MA. The impact of prefrontal transcranial direct current stimulation (tDCS) on theory of mind, emotion regulation and emotional-behavioral functions in children with autism disorder: A randomized, sham-controlled, and parallel-group study. Autism Res 2022; 15:1985-2003. [PMID: 36069668 DOI: 10.1002/aur.2803] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 08/10/2022] [Indexed: 11/12/2022]
Abstract
Advances in our knowledge about the neuropsychological mechanisms underlying core deficits in autism spectrum disorder (ASD) have produced several novel treatment modalities. One of these approaches is modulation of activity of the brain regions involved in ASD symptoms. This study examined the effects of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) on autism symptom severity, theory of mind, emotion regulation strategies, and emotional-behavioral functions in children with ASD. Thirty-two children (Mage = 10.16, SD = 1.93, range 7-12 years) diagnosed with ASD were randomly assigned to active (N = 17) or sham stimulation (N = 15) groups in a randomized, sham-controlled, parallel-group design. Participants underwent 10 sessions of active (1.5 mA, 15 min, bilateral left anodal/right cathodal DLPFC, 2 sessions per week) or sham tDCS. Autism symptom severity, theory of mind, emotion regulation strategies, and emotional-behavioral functioning of the patients were assessed at baseline, immediately after the intervention, and 1 month after the intervention. A significant improvement of autism symptom severity (i.e., communication), theory of mind (i.e., ToM 3), and emotion regulation strategies was observed for the active as compared to the sham stimulation group at the end of the intervention, and these effects were maintained at the one-month follow-up. The results suggest that repeated tDCS with anodal stimulation of left and cathodal stimulation of right DLPFC improves autism symptom severity as well as social cognition and emotion regulation in ASD.
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Affiliation(s)
- Mehdi Zemestani
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | | | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
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Salehinejad MA, Vosough Y, Nejati V. The Impact of Bilateral Anodal tDCS over Left and Right DLPFC on Executive Functions in Children with ADHD. Brain Sci 2022; 12:brainsci12081098. [PMID: 36009161 PMCID: PMC9406177 DOI: 10.3390/brainsci12081098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is increasingly used for therapeutic purposes in attention-deficit hyperactivity disorder (ADHD). The dorsolateral prefrontal cortex (DLPFC) is the most targeted region of tDCS studies in ADHD. There is limited knowledge and mixed results about the relevance of left or right DLPFCs in ADHD’s cognitive deficits. No study so far has investigated the impact of the increased excitability of both left and right DLPFC with anodal tDCS on cognitive deficits in ADHD. Here, we explored the impact of online bilateral anodal left and right DLPFC tDCS on executive dysfunction in children with ADHD. Twenty-two children with ADHD (mean age ± SD =8.86 ± 1.80) received bilateral anodal online tDCS over the left and right DLPFC (1.5 mA, 15 min) in two separate sessions in active and sham states. They underwent a battery of four neuropsychological tasks of executive functions during stimulation that measured working memory, cognitive flexibility, response inhibition, and executive control. Bilateral anodal left and right DLPFC tDCS did not improve performance on working memory, cognitive flexibility, and response inhibition. Executive control was, however, partially improved for those who received active tDCS first. The upregulation of bilateral DLPFC tDCS with anodal polarity does not improve executive dysfunction in children with ADHD. The unilateral modulation of DLPFC with anodal tDCS may be more beneficial to cognitive deficits in ADHD in light of previous works targeting only left and/or right DLPFC.
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Affiliation(s)
- Mohammad Ali Salehinejad
- Leibniz Research Centre for Working Environment and Human Factors, Department of Psychology and Neurosciences, 44139 Dortmund, Germany
| | - Younes Vosough
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran 1983969411, Iran
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran 1983969411, Iran
- Correspondence:
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Fusco G, Cristiano A, Perazzini A, Aglioti SM. Neuromodulating the performance monitoring network during conflict and error processing in healthy populations: Insights from transcranial electric stimulation studies. Front Integr Neurosci 2022; 16:953928. [PMID: 35965598 PMCID: PMC9368590 DOI: 10.3389/fnint.2022.953928] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/27/2022] [Indexed: 12/05/2022] Open
Abstract
The performance monitoring system is fundamentally important for adapting one’s own behavior in conflicting and error-prone, highly demanding circumstances. Flexible behavior requires that neuronal populations optimize information processing through efficient multi-scale communication. Non-invasive brain stimulation (NIBS) studies using transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES) fields to alter the cortical activity promise to illuminate the neurophysiological mechanisms that underpin neuro-cognitive and behavioral processing and their causal relationship. Here, we focus on the transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) that have been increasingly used in cognitive neuroscience for modulating superficial neural networks in a polarity (tDCS) and frequency/phase (tACS) fashion. Specifically, we discuss recent evidence showing how tDCS and tACS modulate the performance monitoring network in neurotypical samples. Emphasis is given to studies using behavioral tasks tapping conflict and error processing such as the Stroop, the Flanker, and the Simon tasks. The crucial role of mid-frontal brain regions (such as the medial frontal cortex, MFC; and the dorsal anterior cingulate cortex, dACC) and of theta synchronization in monitoring conflict and error is highlighted. We also discuss current technological limitations (e.g., spatial resolution) and the specific methodological strategies needed to properly modulate the cortical and subcortical regions.
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Affiliation(s)
- Gabriele Fusco
- “Sapienza” University of Rome and CLN2S@SAPIENZA, Istituto Italiano di Tecnologia, Rome, Italy
- IRCCS Santa Lucia Foundation, Rome, Italy
- *Correspondence: Gabriele Fusco,
| | - Azzurra Cristiano
- “Sapienza” University of Rome and CLN2S@SAPIENZA, Istituto Italiano di Tecnologia, Rome, Italy
- IRCCS Santa Lucia Foundation, Rome, Italy
| | - Anna Perazzini
- “Sapienza” University of Rome and CLN2S@SAPIENZA, Istituto Italiano di Tecnologia, Rome, Italy
- IRCCS Santa Lucia Foundation, Rome, Italy
| | - Salvatore Maria Aglioti
- “Sapienza” University of Rome and CLN2S@SAPIENZA, Istituto Italiano di Tecnologia, Rome, Italy
- IRCCS Santa Lucia Foundation, Rome, Italy
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Klomjai W, Siripornpanich V, Aneksan B, Vimolratana O, Permpoonputtana K, Tretriluxana J, Thichanpiang P. Effects of cathodal transcranial direct current stimulation on inhibitory and attention control in children and adolescents with attention-deficit hyperactivity disorder: A pilot randomized sham-controlled crossover study. J Psychiatr Res 2022; 150:130-141. [PMID: 35367657 DOI: 10.1016/j.jpsychires.2022.02.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/10/2022] [Accepted: 02/28/2022] [Indexed: 02/07/2023]
Abstract
The pathophysiological of attention-deficit hyperactivity disorder (ADHD) includes hypoactivation of the dorso-lateral prefrontal cortex (DLPFC). Most studies have used anodal (excitatory) transcranial direct current stimulation (tDCS) to improve ADHD symptoms, however, a meta-analysis showed limited effect on improving inhibition, and no evidence of attention improvement. We thus present a pilot protocol for investigating the effect of other montage i.e. cathodal (inhibitory) tDCS on neurophysiological and behavioral measures in ADHD. Eleven participants underwent active (1.5 mA, 20 min) and sham cathodal tDCS over the left DLPFC for 5 consecutive days at a 1-month interval. Quantitative electroencephalography was recorded in a resting state with the eyes opened and closed during visual go/no-go and auditory continuous performance tasks at baseline, after five sessions, and at 1-week and 1-month follow-ups. Correct responses and omission errors were recorded. After five active sessions, alpha power increased in the right frontal area when the eyes were opened, and delta power in the left frontal area and omission errors decreased during go/no-go tasks, with no differences at follow-ups. The results revealed improvements in inhibitory control, but not for attention. No aftereffects were observed in either outcomes. However, the changes found in both hemispheres would probably support the hypothesis that cathodal stimulation over the left DLPFC may increase the activity of the right DLPFC via transcallosal inhibition. Results of this pilot trial would help to design and implement a full-scale randomized control trials for further ADHD research. This study was registered on ClinicalTrials.gov (NCT03955692).
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Affiliation(s)
- Wanalee Klomjai
- Neuro Electrical Stimulation Laboratory (NeuE), Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, 73170, Thailand; Faculty of Physical Therapy Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Vorasith Siripornpanich
- Research Center for Neuroscience, Institute of Molecular Biosciences, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Benchaporn Aneksan
- Neuro Electrical Stimulation Laboratory (NeuE), Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, 73170, Thailand; Faculty of Physical Therapy Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Oranich Vimolratana
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, 57100, Thailand
| | - Kannika Permpoonputtana
- National Institute for Child and Family Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Jarugool Tretriluxana
- Faculty of Physical Therapy Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand; Motor Control and Neural Plasticity Laboratory, Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, 73170, Thailand
| | - Peeradech Thichanpiang
- Faculty of Physical Therapy Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand; Division of Occupational Therapy, Faculty of Physical Therapy Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand.
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Anselmo A, Lucifora C, Rusconi P, Martino G, Craparo G, Salehinejad MA, Vicario CM. Can we rewire criminal mind via non-invasive brain stimulation of prefrontal cortex? Insights from clinical, forensic and social cognition studies. CURRENT PSYCHOLOGY 2022; 42:1-11. [PMID: 35600259 PMCID: PMC9107958 DOI: 10.1007/s12144-022-03210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
Non-compliance with social and legal norms and regulations represents a high burden for society. Social cognition deficits are frequently called into question to explain criminal violence and rule violations in individuals diagnosed with antisocial personality disorder (APD), borderline personality disorder (BPD), and psychopathy. In this article, we proposed to consider the potential benefits of non-invasive brain stimulation (NIBS) to rehabilitate forensic population. We focused on the effects of NIBS of the prefrontal cortex, which is central in social cognition, in modulating aggression and impulsivity in clinical disorders, as well as in forensic population. We also addressed the effect of NIBS on empathy, and theory of mind in non-clinical and/or prison population. The reviewed data provide promising evidence on the beneficial effect of NIBS on aggression/impulsivity dyscontrol and social cognitive functions, suggesting its relevance in promoting reintegration of criminals into society.
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Affiliation(s)
- Anna Anselmo
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, via Concezione 6-8, 98121 Messina, Italy
| | - Chiara Lucifora
- Institute of Cognitive Sciences and Technologies, National Research Council (ISTC-CNR), Roma, RM Italy
| | - Patrice Rusconi
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, via Concezione 6-8, 98121 Messina, Italy
| | - Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Craparo
- Faculty of Human and Social Sciences, UKE-Kore University of Enna, Cittadella Universitaria, 94100 Enna, Italy
| | - Mohammad A. Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Carmelo M. Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, via Concezione 6-8, 98121 Messina, Italy
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D’Aiello B, Battisti A, Lazzaro G, Pani P, De Rossi P, Di Vara S, Pretelli I, Costanzo F, Vicari S, Menghini D. Comparing the Effect of Methylphenidate and Anodal tDCS on Inhibitory Control and Working-Memory in Children and Adolescents with Attention Deficit/Hyperactivity Disorder: A Study Protocol for a Randomized, within-Subject Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084575. [PMID: 35457447 PMCID: PMC9030177 DOI: 10.3390/ijerph19084575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inappropriate levels of attention, hyperactivity, and impulsivity that interfere with individual functioning. The international guidelines recommend targeting ADHD-related neurochemical brain abnormalities by intervening via drug treatment, such as methylphenidate (MPH), as first choice. Drug treatments are usually associated with a huge amount of cost for families and the healthcare system, suspension for low compliance, poor long-term efficacy, and side effects. Transcranial direct current stimulation (tDCS) has been suggested as a possible noninvasive means to safely manipulate brain activity and, in turn, improve behavior and cognition in developmental ages. Several studies have shown that tDCS has the potential to improve ADHD-related cognitive deficits, but the effect of tDCS compared with MPH has never been evaluated. The aim of the present within-subject, sham-controlled, randomized proof-of-concept study is to demonstrate the positive effect of one-session anodal tDCS analogous to the MPH drug on inhibitory control and working memory in children and adolescents with ADHD. We strongly believe that this study protocol will serve to accelerate research into low-cost, drug-free, feasible interventions for ADHD.
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Affiliation(s)
- Barbara D’Aiello
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (A.B.); (G.L.); (P.D.R.); (S.D.V.); (I.P.); (F.C.); (S.V.)
- Department of Human Science, LUMSA University, 00193 Rome, Italy
| | - Andrea Battisti
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (A.B.); (G.L.); (P.D.R.); (S.D.V.); (I.P.); (F.C.); (S.V.)
- Department of Human Science, LUMSA University, 00193 Rome, Italy
| | - Giulia Lazzaro
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (A.B.); (G.L.); (P.D.R.); (S.D.V.); (I.P.); (F.C.); (S.V.)
| | - Pierpaolo Pani
- Department of Physiology and Pharmacology, Sapienza University, 00185 Rome, Italy;
| | - Pietro De Rossi
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (A.B.); (G.L.); (P.D.R.); (S.D.V.); (I.P.); (F.C.); (S.V.)
| | - Silvia Di Vara
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (A.B.); (G.L.); (P.D.R.); (S.D.V.); (I.P.); (F.C.); (S.V.)
| | - Italo Pretelli
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (A.B.); (G.L.); (P.D.R.); (S.D.V.); (I.P.); (F.C.); (S.V.)
| | - Floriana Costanzo
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (A.B.); (G.L.); (P.D.R.); (S.D.V.); (I.P.); (F.C.); (S.V.)
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (A.B.); (G.L.); (P.D.R.); (S.D.V.); (I.P.); (F.C.); (S.V.)
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Centro di Riabilitazione, Casa San Giuseppe, Opera Don Guanella, 00165 Rome, Italy
| | - Deny Menghini
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (A.B.); (G.L.); (P.D.R.); (S.D.V.); (I.P.); (F.C.); (S.V.)
- Correspondence:
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Caputo A, Vicario CM, Cazzato V, Martino G. Editorial: Psychological Factors as Determinants of Medical Conditions, Volume II. Front Psychol 2022; 13:865235. [PMID: 35386893 PMCID: PMC8977586 DOI: 10.3389/fpsyg.2022.865235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrea Caputo
- Department of Dynamic and Clinical Psychology, and Health Studies, University of Rome "Sapienza", Rome, Italy
| | - Carmelo Mario Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| | - Valentina Cazzato
- School of Natural Sciences and Psychology, John Moores University, Liverpool, United Kingdom
| | - Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Camacho‐Conde JA, Gonzalez‐Bermudez MDR, Carretero‐Rey M, Khan ZU. Brain stimulation: a therapeutic approach for the treatment of neurological disorders. CNS Neurosci Ther 2022; 28:5-18. [PMID: 34859593 PMCID: PMC8673710 DOI: 10.1111/cns.13769] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 01/14/2023] Open
Abstract
Brain stimulation has become one of the most acceptable therapeutic approaches in recent years and a powerful tool in the remedy against neurological diseases. Brain stimulation is achieved through the application of electric currents using non-invasive as well as invasive techniques. Recent technological advancements have evolved into the development of precise devices with capacity to produce well-controlled and effective brain stimulation. Currently, most used non-invasive techniques are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), whereas the most common invasive technique is deep brain stimulation (DBS). In last decade, application of these brain stimulation techniques has not only exploded but also expanded to wide variety of neurological disorders. Therefore, in the current review, we will provide an overview of the potential of both non-invasive (rTMS and tDCS) and invasive (DBS) brain stimulation techniques in the treatment of such brain diseases.
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Affiliation(s)
- Jose Antonio Camacho‐Conde
- Laboratory of NeurobiologyCIMESUniversity of MalagaMalagaSpain
- Department of MedicineFaculty of MedicineUniversity of MalagaMalagaSpain
| | | | - Marta Carretero‐Rey
- Laboratory of NeurobiologyCIMESUniversity of MalagaMalagaSpain
- Department of MedicineFaculty of MedicineUniversity of MalagaMalagaSpain
| | - Zafar U. Khan
- Laboratory of NeurobiologyCIMESUniversity of MalagaMalagaSpain
- Department of MedicineFaculty of MedicineUniversity of MalagaMalagaSpain
- CIBERNEDInstitute of Health Carlos IIIMadridSpain
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Nejati V, Rasanan AHH, Rad JA, Alavi MM, Haghi S, Nitsche MA. Transcranial direct current stimulation (tDCS) alters the pattern of information processing in children with ADHD: Evidence from drift diffusion modeling. Neurophysiol Clin 2021; 52:17-27. [PMID: 34937687 DOI: 10.1016/j.neucli.2021.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Performance accuracy and reaction time in cognitive tasks are routinely used to evaluate the efficacy of tDCS to affect cognitive task performance. tDCS alters the excitability of targeted brain areas and thereby alters performance of cognitive tasks. The drift diffusion model (DDM) provides some additional measures to explore information processing style, such as (non)decision time, bias for decision, and speed of information processing. DDM parameters are informative for the study of cognitive impairments in children with ADHD. In the present study, we aimed to evaluate the impact of tDCS on cognitive performance via DDM measures. METHODS This study conducted DDM modeling and reanalysis of two exploratory, single-blinded, within-subject design experiments, which were published earlier. In the first experiment, twenty- four children with ADHD performed a Go/ No- Go task during anodal or sham tDCS over the right dlPFC. In the second experiment, twenty- five children with ADHD performed the 1- back working memory task during anodal or sham tDCS over the left dlPFC. We reanalyzed the data after DDM modeling. RESULTS The conventional performance measures revealed no significant effect of tDCS on No- Go accuracy in the first experiment and 1-back accuracy in the second experiment. The 1-back reaction time and speed-accuracy tradeoff were however improved under the real stimulation condition. The DDM measures identified increased No-Go- bias and decision time with respect to inhibitory control, and an increased threshold and amount of information required for response in the 1- back test. CONCLUSION In children with ADHD, anodal tDCS over the right dlPFC induces more conservative and less impulsive decisions. Furthermore, anodal tDCS over the left dlPFC enhanced efficacy of working memory performance with respect to agility and capacity. The experimental results show that drift diffusion modeling is useful for evaluation of the impact of tDCS on the style of information processing.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University Tehran, Tehran, Iran.
| | - Amir Hosein Hadian Rasanan
- Department of Cognitive Modelling, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Jamal Amani Rad
- Department of Cognitive Modelling, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | | | - Shahin Haghi
- Raftar Cognitive Neuroscience Research Center, Shahid Beheshti University, Tehran, Iran
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Department of Psychology and Neurosciences, Dortmund, Germany; University Medical Hospital Bergmannsheil, Department of Neurology, Bochum, Germany
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Alizadehgoradel J, Imani S, Nejati V, Vanderhasselt MA, Molaei B, Salehinejad MA, Ahmadi S, Taherifard M. Improved Executive Functions and Reduced Craving in Youths with Methamphetamine Addiction: Evidence from Combined Transcranial Direct Current Stimulation with Mindfulness Treatment. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2021; 19:653-668. [PMID: 34690120 PMCID: PMC8553531 DOI: 10.9758/cpn.2021.19.4.653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Transcranial direct current stimulation (tDCS) and mindfulness practices have been proposed as a potential approach to improve executive functions (EFs) and reduce craving in persons with substance use disorders. Based on the neural mechanisms of action of each of these interventions, the combination of both non-pharmacological interventions might have additive effects. In the current study, the effects of tDCS combined with mindfulness-based substance abuse treatment (MBSAT) to improve EFs and reduce craving were investigated in early abstinent methamphetamine abuse. METHODS Eighty (youths aged between 18 and 21) early-abstinent methamphetamine users were randomly assigned to the research groups (tDCS group [n = 20], mindfulness group [n = 20], combined mindfulness-tDCS group [n = 20], and sham group [n = 20]). Active tDCS (1.5 mA,20 min, 12 sessions) or sham tDCS was appliedover the left dorsolateral prefrontal cortex and the MBSAT protocol was used over twelve 50-min sessions. RESULTS Both in the post-test phase (immediately after the intervention) and follow-up phase (one month after the intervention), performance in most EFs tasks significantly improved in the combination group which received real tDCS + MBSAT, as compared to baseline values and sham stimulation group. Similarly, a significant reduction in craving was observed after intervention inall treatment groups, but not the sham stimulation group. Interestingly, the increase in EFs and the reduction in craving post versus pre tDCS + MBSAT intervention were correlated. CONCLUSION Findings from the current study provide initial support for the clinical effectiveness of combination tDCS + MBSAT, possibly influencing cognitive/affective processes.
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Affiliation(s)
- Jaber Alizadehgoradel
- Department of Clinical and Health Psychology, Shahid Beheshti University, Tehran, Iran
| | - Saeed Imani
- Department of Clinical and Health Psychology & Counseling Group, Shahid Beheshti University, Tehran, Iran
| | - Vahid Nejati
- Department of Clinical and Health Psychology, Faculty of Education & Psychology, Shahid Beheshti University, Tehran, Iran
| | - Marie-Anne Vanderhasselt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent, Belgium
| | - Behnam Molaei
- Department of Psychiatry, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Ruhr-University Bochum, International Graduate School of Neuroscience, Bochum, Germany
| | - Shirin Ahmadi
- Department of Psychology, Mohaghegh-Ardabili University, Ardabil, Iran
| | - Mina Taherifard
- Department of Psychology, Mohaghegh-Ardabili University, Ardabil, Iran
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Standard Non-Personalized Electric Field Modeling of Twenty Typical tDCS Electrode Configurations via the Computational Finite Element Method: Contributions and Limitations of Two Different Approaches. BIOLOGY 2021; 10:biology10121230. [PMID: 34943145 PMCID: PMC8698402 DOI: 10.3390/biology10121230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/23/2021] [Indexed: 11/17/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation procedure to modulate cortical excitability and related brain functions. tDCS can effectively alter multiple brain functions in healthy humans and is suggested as a therapeutic tool in several neurological and psychiatric diseases. However, variability of results is an important limitation of this method. This variability may be due to multiple factors, including age, head and brain anatomy (including skull, skin, CSF and meninges), cognitive reserve and baseline performance level, specific task demands, as well as comorbidities in clinical settings. Different electrode montages are a further source of variability between tDCS studies. A procedure to estimate the electric field generated by specific tDCS electrode configurations, which can be helpful to adapt stimulation protocols, is the computational finite element method. This approach is useful to provide a priori modeling of the current spread and electric field intensity that will be generated according to the implemented electrode montage. Here, we present standard, non-personalized model-based electric field simulations for motor, dorsolateral prefrontal, and posterior parietal cortex stimulation according to twenty typical tDCS electrode configurations using two different current flow modeling software packages. The resulting simulated maximum intensity of the electric field, focality, and current spread were similar, but not identical, between models. The advantages and limitations of both mathematical simulations of the electric field are presented and discussed systematically, including aspects that, at present, prevent more widespread application of respective simulation approaches in the field of non-invasive brain stimulation.
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Wischnewski M, Mantell KE, Opitz A. Identifying regions in prefrontal cortex related to working memory improvement: A novel meta-analytic method using electric field modeling. Neurosci Biobehav Rev 2021; 130:147-161. [PMID: 34418436 DOI: 10.1016/j.neubiorev.2021.08.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/09/2021] [Accepted: 08/15/2021] [Indexed: 12/17/2022]
Abstract
Altering cortical activity using transcranial direct current stimulation (tDCS) has been shown to improve working memory (WM) performance. Due to large inter-experimental variability in the tDCS montage configuration and strength of induced electric fields, results have been mixed. Here, we present a novel meta-analytic method relating behavioral effect sizes to electric field strength to identify brain regions underlying largest tDCS-induced WM improvement. Simulations on 69 studies targeting left prefrontal cortex showed that tDCS electric field strength in lower dorsolateral prefrontal cortex (Brodmann area 45/47) relates most strongly to improved WM performance. This region explained 7.8 % of variance, equaling a medium effect. A similar region was identified when correlating WM performance and electric field strength of right prefrontal tDCS studies (n = 18). Maximum electric field strength of five previously used tDCS configurations were outside of this location. We thus propose a new tDCS montage which maximizes the tDCS electric field strength in that brain region. Our findings can benefit future tDCS studies that aim to affect WM function.
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Affiliation(s)
- Miles Wischnewski
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States.
| | - Kathleen E Mantell
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Alexander Opitz
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
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Pol F, Salehinejad MA, Baharlouei H, Nitsche MA. The effects of transcranial direct current stimulation on gait in patients with Parkinson's disease: a systematic review. Transl Neurodegener 2021; 10:22. [PMID: 34183062 PMCID: PMC8240267 DOI: 10.1186/s40035-021-00245-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022] Open
Abstract
Background Gait problems are an important symptom in Parkinson’s disease (PD), a progressive neurodegenerative disease. Transcranial direct current stimulation (tDCS) is a neuromodulatory intervention that can modulate cortical excitability of the gait-related regions. Despite an increasing number of gait-related tDCS studies in PD, the efficacy of this technique for improving gait has not been systematically investigated yet. Here, we aimed to systematically explore the effects of tDCS on gait in PD, based on available experimental studies. Methods Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, PubMed, Web of Science, Scopus, and PEDro databases were searched for randomized clinical trials assessing the effect of tDCS on gait in patients with PD. Results Eighteen studies were included in this systematic review. Overall, tDCS targeting the motor cortex and supplementary motor area bilaterally seems to be promising for gait rehabilitation in PD. Studies of tDCS targeting the dorosolateral prefrontal cortex or cerebellum showed more heterogeneous results. More studies are needed to systematically compare the efficacy of different tDCS protocols, including protocols applying tDCS alone and/or in combination with conventional gait rehabilitation treatment in PD. Conclusions tDCS is a promising intervention approach to improving gait in PD. Anodal tDCS over the motor areas has shown a positive effect on gait, but stimulation of other areas is less promising. However, the heterogeneities of methods and results have made it difficult to draw firm conclusions. Therefore, systematic explorations of tDCS protocols are required to optimize the efficacy.
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Affiliation(s)
- Fateme Pol
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Hamzeh Baharlouei
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
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Jafari E, Alizadehgoradel J, Pourmohseni Koluri F, Nikoozadehkordmirza E, Refahi M, Taherifard M, Nejati V, Hallajian AH, Ghanavati E, Vicario CM, Nitsche MA, Salehinejad MA. Intensified electrical stimulation targeting lateral and medial prefrontal cortices for the treatment of social anxiety disorder: A randomized, double-blind, parallel-group, dose-comparison study. Brain Stimul 2021; 14:974-986. [PMID: 34167918 DOI: 10.1016/j.brs.2021.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Social Anxiety Disorder (SAD) is the most common anxiety disorder while remains largely untreated. Disturbed amygdala-frontal network functions are central to the pathophysiology of SAD, marked by hypoactivity of the lateral prefrontal cortex (PFC), and hypersensitivity of the medial PFC and the amygdala. The objective of this study was to determine whether modulation of the dorsolateral and medial PFC activity with a novel intensified stimulation protocol reduces SAD core symptoms, improves treatment-related variables, and reduces attention bias to threatening stimuli. METHODS In this randomized, sham-controlled, double-blind trial, we assessed the efficacy of an intensified stimulation protocol (20 min, twice-daily sessions with 20 min intervals, 5 consecutive days) in two intensities (1 vs 2 mA) compared to sham stimulations. 45 patients with SAD were randomized in three tDCS arms (1-mA, 2-mA, sham). SAD symptoms, treatment-related variables (worries, depressive state, emotion regulation, quality of life), and attention bias to threatening stimuli (dot-probe paradigm) were assessed before and right after the intervention. SAD symptoms were also assessed at 2-month follow-up. RESULTS Both 1-mA and 2-mA protocols significantly reduced fear/avoidance symptoms, worries and improved, emotion regulation and quality of life after the intervention compared to the sham group. Improving effect of the 2-mA protocol on avoidance symptoms, worries and depressive state was significantly larger than the 1-mA group. Only the 2-mA protocol reduced attention bias to threat-related stimuli, the avoidance symptom at follow-up, and depressive states, as compared to the sham group. CONCLUSIONS Modulation of lateral-medial PFC activity with intensified stimulation can improve cognitive control, motivation and emotion networks in SAD and might thereby result in therapeutic effects. These effects can be larger with 2-mA vs 1-mA intensities, though a linear relationship between intensity and efficacy should not be concluded. Our results need replication in larger trials.
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Affiliation(s)
- Eisa Jafari
- Department of Psychology, Payame Noor University, Tehran, Iran
| | - Jaber Alizadehgoradel
- Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran.
| | | | | | - Meysam Refahi
- Department of Psychology, Payame Noor University, Tehran, Iran
| | - Mina Taherifard
- Department of Psychology, Mohaghegh-Ardabili University, Ardabil, Iran
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | | | - Elham Ghanavati
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Carmelo M Vicario
- Department of Cognitive Science, University of Messina, Messina, Italy
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
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McCann H, Beltrachini L. Does participant's age impact on tDCS induced fields? Insights from computational simulations. Biomed Phys Eng Express 2021; 7. [PMID: 34038881 DOI: 10.1088/2057-1976/ac0547] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/26/2021] [Indexed: 12/20/2022]
Abstract
Objective: Understanding the induced current flow from transcranial direct current stimulation (tDCS) is essential for determining the optimal dose and treatment. Head tissue conductivities play a key role in the resulting electromagnetic fields. However, there exists a complicated relationship between skull conductivity and participant age, that remains unclear. We explored how variations in skull electrical conductivities, particularly as a suggested function of age, affected tDCS induced electric fields.Approach: Simulations were employed to compare tDCS outcomes for different intensities across head atlases of varying age. Three databases were chosen to demonstrate differing variability in skull conductivity with age and how this may affect induced fields. Differences in tDCS electric fields due to proposed age-dependent skull conductivity variation, as well as deviations in grey matter, white matter and scalp, were compared and the most influential tissues determined.Main results: tDCS induced peak electric fields significantly negatively correlated with age, exacerbated by employing proposed age-appropriate skull conductivity (according to all three datasets). Uncertainty in skull conductivity was the most sensitive to changes in peak fields with increasing age. These results were revealed to be directly due to changing skull conductivity, rather than head geometry alone. There was no correlation between tDCS focality and age.Significance: Accurate and individualised head anatomy andin vivoskull conductivity measurements are essential for modelling tDCS induced fields. In particular, age should be taken into account when considering stimulation dose to precisely predict outcomes.
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Affiliation(s)
- Hannah McCann
- School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom.,Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff, United Kingdom
| | - Leandro Beltrachini
- School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom.,Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff, United Kingdom
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Brauer H, Breitling-Ziegler C, Moliadze V, Galling B, Prehn-Kristensen A. Transcranial direct current stimulation in attention-deficit/hyperactivity disorder: A meta-analysis of clinical efficacy outcomes. PROGRESS IN BRAIN RESEARCH 2021; 264:91-116. [PMID: 34167666 DOI: 10.1016/bs.pbr.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence for the application of transcranial direct current stimulation (tDCS) in the clinical care of attention-deficit/hyperactivity disorder (ADHD) is limited. Therefore, we aimed to summarize study results using meta-analyses of measures of the cardinal symptoms of ADHD. METHODS We conducted a systematic literature search (PubMed/pubpsych/PsychInfo/WOS) until 01/05/2020 for randomized controlled trials (RCTs) evaluating tDCS vs. control condition in patients with ADHD. A random effects meta-analysis of symptom-related outcomes was performed separately for data on the immediate effect and follow-up. Subgroup- and metaregression analyses for patient characteristics and tDCS parameters were included. RESULTS Meta-analyzing 13 studies (n=308, age=23.7±13.3), including 20 study arms, tDCS had an immediate effect on overall symptom severity, inattention, and impulsivity, but not on hyperactivity. Results were significant in children and adolescents (8 studies, n=133, age=12.4±3.0). Follow-up data (3 days-4 weeks after stimulation) suggested an ongoing beneficial effect regarding overall symptom severity and a delayed effect on hyperactivity. DISCUSSION TDCS seems to be a promising method to treat clinical symptoms in ADHD with long-lasting effects. Still, more research considering the individual neuropsychological and anatomical dispositions of the subjects is needed to optimize tDCS protocols and efficacy. Safety issues of tDCS treatment in children and adolescents are addressed.
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Affiliation(s)
- Hannah Brauer
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, School of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany.
| | - Carolin Breitling-Ziegler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel, Germany
| | - Britta Galling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, School of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany; Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Child and Adolescent Psychosomatic Medicine and Psychotherapy, Altona Children's Hospital, Hamburg, Germany
| | - Alexander Prehn-Kristensen
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, School of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
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