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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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Shinn AK, Hurtado-Puerto AM, Roh YS, Ho V, Hwang M, Cohen BM, Öngür D, Camprodon JA. Cerebellar transcranial magnetic stimulation in psychotic disorders: intermittent, continuous, and sham theta-burst stimulation on time perception and symptom severity. Front Psychiatry 2023; 14:1218321. [PMID: 38025437 PMCID: PMC10679721 DOI: 10.3389/fpsyt.2023.1218321] [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: 05/07/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background The cerebellum contributes to the precise timing of non-motor and motor functions, and cerebellum abnormalities have been implicated in psychosis pathophysiology. In this study, we explored the effects of cerebellar theta burst stimulation (TBS), an efficient transcranial magnetic stimulation protocol, on temporal discrimination and self-reported mood and psychotic symptoms. Methods We conducted a case-crossover study in which patients with psychosis (schizophrenias, schizoaffective disorders, or bipolar disorders with psychotic features) were assigned to three sessions of TBS to the cerebellar vermis: one session each of intermittent (iTBS), continuous (cTBS), and sham TBS. Of 28 enrolled patients, 26 underwent at least one TBS session, and 20 completed all three. Before and immediately following TBS, participants rated their mood and psychotic symptoms and performed a time interval discrimination task (IDT). We hypothesized that cerebellar iTBS and cTBS would modulate these measures in opposing directions, with iTBS being adaptive and cTBS maladaptive. Results Reaction time (RT) in the IDT decreased significantly after iTBS vs. Sham (LS-mean difference = -73.3, p = 0.0001, Cohen's d = 1.62), after iTBS vs. cTBS (LS-mean difference = -137.6, p < 0.0001, d = 2.03), and after Sham vs. cTBS (LS-mean difference = -64.4, p < 0.0001, d = 1.33). We found no effect on IDT accuracy. We did not observe any effects on symptom severity after correcting for multiple comparisons. Conclusion We observed a frequency-dependent dissociation between the effects of iTBS vs. cTBS to the cerebellar midline on the reaction time of interval discrimination in patients with psychosis. iTBS showed improved (adaptive) while cTBS led to worsening (maladaptive) speed of response. These results demonstrate behavioral target engagement in a cognitive dimension of relevance to patients with psychosis and generate testable hypotheses about the potential therapeutic role of cerebellar iTBS in this clinical population. Clinical Trial Registration clinicaltrials.gov, identifier NCT02642029.
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Affiliation(s)
- Ann K. Shinn
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Aura M. Hurtado-Puerto
- Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, MA, United States
| | - Youkyung S. Roh
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
| | - Victoria Ho
- Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, MA, United States
| | - Melissa Hwang
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
| | - Bruce M. Cohen
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Program for Neuropsychiatric Research, McLean Hospital, Belmont, MA, United States
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Joan A. Camprodon
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, MA, United States
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3
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Liu Y, Liu Q, Zhao J, Leng X, Han J, Xia F, Pang Y, Chen H. Anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex improves attentional control in chronically stressed adults. Front Neurosci 2023; 17:1182728. [PMID: 37397442 PMCID: PMC10309114 DOI: 10.3389/fnins.2023.1182728] [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: 03/09/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Chronic stress is a long-term condition that negatively affects cognitive ability and mental health. Individuals who experience chronic stress show poor attentional control. Transcranial direct current stimulation (tDCS) to the dorsolateral prefrontal cortex (DLPFC) modulates executive function domains. Therefore, it is beneficial to investigate whether tDCS of the DLPFC could improve attentional control and relieve stress in chronically stressed individuals. Methods We assess the event-related potentials (ERPs) associated with attentional control in individuals with chronic stress after the tDCS intervention. Forty individuals were randomly assigned to either the anodal tDCS group, which received 5 sessions of the 20 min tDCS over the DLPFC (2 mA; n = 20), or the sham tDCS (n = 20). Participants' stress levels, anxiety, depressive symptoms, and state affects were assessed and compared before and after the intervention. The ERP was collected through electroencephalography (EEG) technology during an attentional network test. Results After the anodal tDCS, we found a significant decrease in the perceived stress scale (PSS) scores (from an average score of 35.05 to 27.75), p = 0.01 as well as the State-Trait Anxiety Inventory (STAI) scores, p = 0.002. Better performance in the attentional network test, a significant reduction in the N2 amplitudes, and an enhancement in the P3 amplitudes (both cues and targets) were also found in the anodal tDCS group. Discussion Our study findings suggest that tDCS to the left DLPFC could effectively relieve chronic stress, potentially reflected by increased attentional control.
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Affiliation(s)
- Yong Liu
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, China
- School of Psychology, Southwest University, Chongqing, China
| | - Qingjin Liu
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
- MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Jia Zhao
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, China
- School of Psychology, Southwest University, Chongqing, China
| | - Xuechen Leng
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, China
- School of Psychology, Southwest University, Chongqing, China
| | - Jinfeng Han
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, China
- School of Psychology, Southwest University, Chongqing, China
| | - Feng Xia
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yazhi Pang
- School of Psychology, Southwest University, Chongqing, China
| | - Hong Chen
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, China
- School of Psychology, Southwest University, Chongqing, China
- Faculty of Psychology, Research Center of Psychology and Social Development, Southwest University, Chongqing, China
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Hayden A, Hooley JM, Dougherty DD, Camprodon JA, Chou T. Neuroticism modulates the qualitative effects of inferior parietal tDCS on negatively-valenced memories. J Psychiatr Res 2023; 161:467-475. [PMID: 37060719 DOI: 10.1016/j.jpsychires.2023.04.005] [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: 01/06/2023] [Revised: 03/29/2023] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
For individuals with increased levels of neuroticism, experiencing criticism or receiving negative feedback has been associated with worse psychological and cognitive outcomes. Transcranial direct current stimulation (tDCS) can change cognitive processes in clinical populations. We bilaterally stimulated the posterior inferior parietal lobule (pIPL), a critical superficial node of the default model network. We investigated how baseline neuroticism modulates the impact of bilateral tDCS to pIPL on qualitative measures of memory after hearing criticism, hypothesizing that cathodal stimulation of the IPL would offer qualitative memory improvements for individuals with higher levels of neuroticism. Ninety individuals from the community were randomly assigned to receive anodal, cathodal, or sham stimulation while they were exposed to critical comments before and after stimulation. Participants then recalled the critical comments, and their linguistic responses were analyzed using Pennebaker's Linguistic Inquiry and Word Count software, a quantitative analysis software for linguistic data. Results showed that for individuals receiving cathodal tDCS, higher neuroticism scores corresponded with greater proportions of non-personal language (i.e., words such as "us," "they," or "other" instead of "I" or "me") when recalling negative feedback. For individuals with higher neuroticism, cathodal tDCS stimulation, rather than anodal or sham, of the pIPL prompted increased emotional distancing and perspective taking strategies when recalling criticism. These results further highlight the state-dependent nature of tDCS effects and the role of the IPL in interpersonal processing - a clinically meaningful outcome that current tDCS studies solely examining quantitative measures of memory (e.g., task-based accuracy or speed) do not reveal.
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Affiliation(s)
- Ashley Hayden
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.
| | | | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - Tina Chou
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
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Newhouse A, Kritzer MD, Eryilmaz H, Praschan N, Camprodon JA, Fricchione G, Chemali Z. Neurocircuitry Hypothesis and Clinical Experience in Treating Neuropsychiatric Symptoms of Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2. J Acad Consult Liaison Psychiatry 2022; 63:619-627. [PMID: 36030055 PMCID: PMC9404079 DOI: 10.1016/j.jaclp.2022.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022]
Abstract
Persistent symptoms following COVID-19 infection have been termed postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection. Many of these symptoms are neuropsychiatric, such as inattention, impaired memory, and executive dysfunction; these are often colloquially termed "brain fog". These symptoms are common and often persist long after the acute phase. The pattern of these deficits combined with laboratory, neuroimaging, electroencephalographic, and neuropsychological data suggest that these symptoms may be driven by direct and indirect damage to the frontal-subcortical neural networks. Here, we review this evidence, share our clinical experience at an academic medical center, and discuss potential treatment implications. While the exact etiology remains unknown, a neurocircuit-informed understanding of postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection can help guide pharmacology, neuromodulation, and physical and psychological therapeutic approaches.
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Affiliation(s)
- Amy Newhouse
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA.
| | - Michael D Kritzer
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Hamdi Eryilmaz
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Nathan Praschan
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Zeina Chemali
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Leffa DT, Grevet EH, Bau CHD, Schneider M, Ferrazza CP, da Silva RF, Miranda MS, Picon F, Teche SP, Sanches P, Pereira D, Rubia K, Brunoni AR, Camprodon JA, Caumo W, Rohde LA. Transcranial Direct Current Stimulation vs Sham for the Treatment of Inattention in Adults With Attention-Deficit/Hyperactivity Disorder: The TUNED Randomized Clinical Trial. JAMA Psychiatry 2022; 79:847-856. [PMID: 35921102 PMCID: PMC9350846 DOI: 10.1001/jamapsychiatry.2022.2055] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Transcranial direct current stimulation (tDCS) may improve symptoms of inattention in adults with attention-deficit/hyperactivity disorder (ADHD). However, previous trials are characterized by small sample sizes, heterogeneous methodologies, and short treatment periods using clinic-based tDCS. OBJECTIVE To determine the efficacy and safety of home-based tDCS in treating inattention symptoms in adult patients with ADHD. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, parallel, sham-controlled clinical trial (tDCS for the Treatment of Inattention Symptoms in Adult Patients With ADHD [TUNED]), conducted from July 2019 through July 2021 in a single-center outpatient academic setting. Of 277 potential participants screened by phone, 150 were assessed for eligibility on site, and 64 were included. Participants were adults with ADHD, inattentive or combined subtype. Exclusion criteria included current stimulant drug treatment, current moderate to severe symptoms of depression or anxiety, diagnosis of bipolar disorder with a manic or depressive episode in the last year, diagnosis of schizophrenia or another psychotic disorder, and diagnosis of autism spectrum disorder; 55 of participants completed follow-up after 4 weeks. INTERVENTIONS Thirty-minute daily sessions of home-based tDCS for 4 weeks, 2 mA anodal-right and cathodal-left prefrontal stimulation with 35-cm2 carbon electrodes. MAIN OUTCOMES AND MEASURES Inattentive scores in the clinician-administered version of the Adult ADHD Self-report Scale version 1.1 (CASRS-I). RESULTS Included in this trial were 64 participants with ADHD (31 [48%] inattentive presentation and 33 [52%] combined presentation), with a mean (SD) age of 38.3 (9.6) years. Thirty participants (47%) were women and 34 (53%) were men. Fifty-five finished the trial. At week 4, the mean (SD) inattention score, as measured with CASRS-I, was 18.88 (5.79) in the active tDCS group and 23.63 (3.97) in the sham tDCS group. Linear mixed-effects models revealed a statistically significant treatment by time interaction for CASRS-I (βinteraction = -3.18; 95% CI, -4.60 to -1.75; P < .001), showing decreased symptoms of inattention in the active tDCS group over the 3 assessments compared to the sham tDCS group. Mild adverse events were more frequent in the active tDCS group, particularly skin redness, headache, and scalp burn. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, daily treatment with a home-based tDCS device over 4 weeks improved attention in adult patients with ADHD who were not taking stimulant medication. Home-based tDCS could be a nonpharmacological alternative for patients with ADHD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04003740.
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Affiliation(s)
- Douglas Teixeira Leffa
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eugenio Horacio Grevet
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Claiton Henrique Dotto Bau
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,Department of Genetics, Institute of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maitê Schneider
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Prietto Ferrazza
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Roberta Francieli da Silva
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marina Silva Miranda
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Picon
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Stefania Pigatto Teche
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo Sanches
- Laboratory of Biomedical Engineer, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Danton Pereira
- Laboratory of Biomedical Engineer, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - André Russowsky Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Universidade de São Paulo, São Paulo, Brazil
| | - Joan A. Camprodon
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Wolnei Caumo
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luis Augusto Rohde
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
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Li Q, Fu Y, Liu C, Meng Z. Transcranial Direct Current Stimulation of the Dorsolateral Prefrontal Cortex for Treatment of Neuropsychiatric Disorders. Front Behav Neurosci 2022; 16:893955. [PMID: 35711693 PMCID: PMC9195619 DOI: 10.3389/fnbeh.2022.893955] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/04/2022] [Indexed: 12/16/2022] Open
Abstract
Background The dorsolateral prefrontal cortex (DLPFC) is a key node of the frontal cognitive circuit. It is involved in executive control and many cognitive processes. Abnormal activities of DLPFC are likely associated with many psychiatric diseases. Modulation of DLPFC may have potential beneficial effects in many neural and psychiatric diseases. One of the widely used non-invasive neuromodulation technique is called transcranial direct current stimulation (or tDCS), which is a portable and affordable brain stimulation approach that uses direct electrical currents to modulate brain functions. Objective This review aims to discuss the results from the past two decades which have shown that tDCS can relieve clinical symptoms in various neurological and psychiatric diseases. Methods Here, we performed searches on PubMed to collect clinical and preclinical studies that using tDCS as neuromodulation technique, DLPFC as the stimulation target in treating neuropsychiatric disorders. We summarized the stimulation sites, stimulation parameters, and the overall effects in these studies. Results Overall, tDCS stimulation of DLPFC could alleviate the clinical symptoms of schizophrenia, depression, drug addiction, attention deficit hyperactivity disorder and other mental disorders. Conclusion The stimulation parameters used in these studies were different from each other. The lasting effect of stimulation was also not consistent. Nevertheless, DLPFC is a promising target for non-invasive stimulation in many psychiatric disorders. TDCS is a safe and affordable neuromodulation approach that has potential clinical uses. Larger clinical studies will be needed to determine the optimal stimulation parameters in each condition.
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Affiliation(s)
- Qing Li
- Medical School, Kunming University of Science and Technology, Kunming, China
- Shenzhen Key Laboratory of Drug Addiction, Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yu Fu
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Chang Liu
- Shenzhen Key Laboratory of Viral Vectors for Biomedicine, Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Fundamental Research Institutions, Shenzhen, China
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- *Correspondence: Chang Liu,
| | - Zhiqiang Meng
- Shenzhen Key Laboratory of Drug Addiction, Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Fundamental Research Institutions, Shenzhen, China
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Zhiqiang Meng,
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8
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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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Rubia K, Westwood S, Aggensteiner PM, Brandeis D. Neurotherapeutics for Attention Deficit/Hyperactivity Disorder (ADHD): A Review. Cells 2021; 10:cells10082156. [PMID: 34440925 PMCID: PMC8394071 DOI: 10.3390/cells10082156] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/07/2021] [Accepted: 08/18/2021] [Indexed: 01/19/2023] Open
Abstract
This review focuses on the evidence for neurotherapeutics for attention deficit/hyperactivity disorder (ADHD). EEG-neurofeedback has been tested for about 45 years, with the latest meta-analyses of randomised controlled trials (RCT) showing small/medium effects compared to non-active controls only. Three small studies piloted neurofeedback of frontal activations in ADHD using functional magnetic resonance imaging or near-infrared spectroscopy, finding no superior effects over control conditions. Brain stimulation has been applied to ADHD using mostly repetitive transcranial magnetic and direct current stimulation (rTMS/tDCS). rTMS has shown mostly negative findings on improving cognition or symptoms. Meta-analyses of tDCS studies targeting mostly the dorsolateral prefrontal cortex show small effects on cognitive improvements with only two out of three studies showing clinical improvements. Trigeminal nerve stimulation has been shown to improve ADHD symptoms with medium effect in one RCT. Modern neurotherapeutics are attractive due to their relative safety and potential neuroplastic effects. However, they need to be thoroughly tested for clinical and cognitive efficacy across settings and beyond core symptoms and for their potential for individualised treatment.
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Affiliation(s)
- Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London SE5 8AF, UK;
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London SE5 8AF, UK
- Department of Child & Adolescent Psychiatry, Transcampus, Dresden University, 01307 Dresden, Germany
- Correspondence:
| | - Samuel Westwood
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London SE5 8AF, UK;
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London SE5 8AF, UK
- Department of Psychology, Wolverhampton University, Wolverhampton WV1 1LY, UK
| | - Pascal-M. Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159 Mannheim, Germany; (P.-M.A.); (D.B.)
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159 Mannheim, Germany; (P.-M.A.); (D.B.)
- Department of Child and Adolescent Psychiatry and Psychotherapy, Hospital of Psychiatry, Psychiatric Hospital University, University of Zürich, 8032 Zürich, Switzerland
- Neuroscience Center Zürich, Swiss Federal Institute of Technology and University of Zürich, 8057 Zürich, Switzerland
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