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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; 61:e14651. [PMID: 38997805 DOI: 10.1111/psyp.14651] [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: 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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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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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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Lisoni J, Nibbio G, Baldacci G, Cicale A, Zucchetti A, Bertoni L, Calzavara Pinton I, Necchini N, Deste G, Barlati S, Vita A. What impact can brain stimulation interventions have on borderline personality disorder? Expert Rev Neurother 2024; 24:343-360. [PMID: 38349069 DOI: 10.1080/14737175.2024.2316133] [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: 08/20/2023] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a severe mental disorder characterized by emotion dysregulation, impulsivity, neuropsychological impairment, and interpersonal instability, presenting with multiple psychiatric comorbidities, functional disability and reduced life expectancy due suicidal behaviors. AREAS COVERED In this perspective, the authors explore the application of noninvasive brain stimulation (NIBS) (rTMS, tDCS, and MST) in BPD individuals by considering a symptom-based approach, focusing on general BPD psychopathology, impulsivity and neuropsychological impairments, suicidality and depressive/anxious symptoms, and emotion dysregulation. EXPERT OPINION According to a symptoms-based approach, NIBS interventions (particularly rTMS and tDCS) are promising treatment options for BPD individuals improving core symptoms such as emotional and behavioral dysregulation, neuropsychological impairments and depressive symptoms. However, the heterogeneity of stimulation protocols and of assessment tools used to detect these changes limits the possibility to provide definitive recommendations according to a symptom-based approach. To implement such armamentarium in clinical practice, future NIIBS studies should further consider a lifespan perspective due to clinical variability over time, the role of psychiatric comorbidities affecting BPD individuals and the need to combine NIBS with specialized psychotherapeutic approaches for BPD patients and with functional neuroimaging studies.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Zucchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Bertoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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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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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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Uslu S, Tangermann M, Vögele C. Estimating person-specific neural correlates of mental rotation: A machine learning approach. PLoS One 2024; 19:e0289094. [PMID: 38295045 PMCID: PMC10830051 DOI: 10.1371/journal.pone.0289094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Using neurophysiological measures to model how the brain performs complex cognitive tasks such as mental rotation is a promising way towards precise predictions of behavioural responses. The mental rotation task requires objects to be mentally rotated in space. It has been used to monitor progressive neurological disorders. Up until now, research on neural correlates of mental rotation have largely focused on group analyses yielding models with features common across individuals. Here, we propose an individually tailored machine learning approach to identify person-specific patterns of neural activity during mental rotation. We trained ridge regressions to predict the reaction time of correct responses in a mental rotation task using task-related, electroencephalographic (EEG) activity of the same person. When tested on independent data of the same person, the regression model predicted the reaction times significantly more accurately than when only the average reaction time was used for prediction (bootstrap mean difference of 0.02, 95% CI: 0.01-0.03, p < .001). When tested on another person's data, the predictions were significantly less accurate compared to within-person predictions. Further analyses revealed that considering person-specific reaction times and topographical activity patterns substantially improved a model's generalizability. Our results indicate that a more individualized approach towards neural correlates can improve their predictive performance of behavioural responses, particularly when combined with machine learning.
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Affiliation(s)
- Sinan Uslu
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Michael Tangermann
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Claus Vögele
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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Mattioli F, Maglianella V, D'Antonio S, Trimarco E, Caligiore D. Non-invasive brain stimulation for patients and healthy subjects: Current challenges and future perspectives. J Neurol Sci 2024; 456:122825. [PMID: 38103417 DOI: 10.1016/j.jns.2023.122825] [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: 07/06/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
Non-invasive brain stimulation (NIBS) techniques have a rich historical background, yet their utilization has witnessed significant growth only recently. These techniques encompass transcranial electrical stimulation and transcranial magnetic stimulation, which were initially employed in neuroscience to explore the intricate relationship between the brain and behaviour. However, they are increasingly finding application in research contexts as a means to address various neurological, psychiatric, and neurodegenerative disorders. This article aims to fulfill two primary objectives. Firstly, it seeks to showcase the current state of the art in the clinical application of NIBS, highlighting how it can improve and complement existing treatments. Secondly, it provides a comprehensive overview of the utilization of NIBS in augmenting the brain function of healthy individuals, thereby enhancing their performance. Furthermore, the article delves into the points of convergence and divergence between these two techniques. It also addresses the existing challenges and future prospects associated with NIBS from ethical and research standpoints.
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Affiliation(s)
- Francesco Mattioli
- AI2Life s.r.l., Innovative Start-Up, ISTC-CNR Spin-Off, Via Sebino 32, 00199 Rome, Italy; School of Computing, Electronics and Mathematics, University of Plymouth, Drake Circus, Plymouth PL4 8AA, United Kingdom
| | - Valerio Maglianella
- Computational and Translational Neuroscience Laboratory, Institute of Cognitive Sciences and Technologies, National Research Council (CTNLab-ISTC-CNR), Via San Martino della Battaglia 44, 00185 Rome, Italy
| | - Sara D'Antonio
- Computational and Translational Neuroscience Laboratory, Institute of Cognitive Sciences and Technologies, National Research Council (CTNLab-ISTC-CNR), Via San Martino della Battaglia 44, 00185 Rome, Italy
| | - Emiliano Trimarco
- Computational and Translational Neuroscience Laboratory, Institute of Cognitive Sciences and Technologies, National Research Council (CTNLab-ISTC-CNR), Via San Martino della Battaglia 44, 00185 Rome, Italy
| | - Daniele Caligiore
- AI2Life s.r.l., Innovative Start-Up, ISTC-CNR Spin-Off, Via Sebino 32, 00199 Rome, Italy; Computational and Translational Neuroscience Laboratory, Institute of Cognitive Sciences and Technologies, National Research Council (CTNLab-ISTC-CNR), Via San Martino della Battaglia 44, 00185 Rome, Italy.
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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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Narmashiri A, Akbari F. The Effects of Transcranial Direct Current Stimulation (tDCS) on the Cognitive Functions: A Systematic Review and Meta-analysis. Neuropsychol Rev 2023:10.1007/s11065-023-09627-x. [PMID: 38060075 DOI: 10.1007/s11065-023-09627-x] [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: 04/01/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
Previous studies have investigated the effect of transcranial direct current stimulation (tDCS) on cognitive functions. However, these studies reported inconsistent results due to differences in experiment design, measurements, and stimulation parameters. Nonetheless, there is a lack of meta-analyses and review studies on tDCS and its impact on cognitive functions, including working memory, inhibition, flexibility, and theory of mind. We performed a systematic review and meta-analysis of tDCS studies published from the earliest available data up to October 2021, including studies reporting the effects of tDCS on cognitive functions in human populations. Therefore, these systematic review and meta-analysis aim to comprehensively analyze the effects of anodal and cathodal tDCS on cognitive functions by investigating 69 articles with a total of 5545 participants. Our study reveals significant anodal tDCS effects on various cognitive functions. Specifically, we observed improvements in working memory reaction time (RT), inhibition RT, flexibility RT, theory of mind RT, working memory accuracy, theory of mind accuracy and flexibility accuracy. Furthermore, our findings demonstrate noteworthy cathodal tDCS effects, enhancing working memory accuracy, inhibition accuracy, flexibility RT, flexibility accuracy, theory of mind RT, and theory of mind accuracy. Notably, regarding the influence of stimulation parameters of tDCS on cognitive functions, the results indicated significant differences across various aspects, including the timing of stimulation (online vs. offline studies), population type (clinical vs. healthy studies), stimulation duration (< 15 min vs. > 15 min), electrical current intensities (1-1.5 m.A vs. > 1.5 m.A), stimulation sites (right frontal vs. left frontal studies), age groups (young vs. older studies), and different cognitive tasks in each cognitive functioning aspect. In conclusion, our results demonstrate that tDCS can effectively enhance cognitive task performance, offering valuable insights into the potential benefits of this method for cognitive improvement.
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Affiliation(s)
- Abdolvahed Narmashiri
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran.
- Electrical Engineering Department, Bio-Intelligence Research Unit, Sharif Brain Center, Sharif University of Technology, Tehran, Iran.
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Chaulagain A, Lyhmann I, Halmøy A, Widding-Havneraas T, Nyttingnes O, Bjelland I, Mykletun A. A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder. Eur Psychiatry 2023; 66:e90. [PMID: 37974470 PMCID: PMC10755583 DOI: 10.1192/j.eurpsy.2023.2451] [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: 01/10/2023] [Revised: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD. METHODS We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria. RESULTS The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the short-term, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed. CONCLUSIONS Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD.
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Affiliation(s)
- Ashmita Chaulagain
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild Lyhmann
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tarjei Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Olav Nyttingnes
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ingvar Bjelland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Centre for Work and Mental Health, Nordland Hospital, Bodø, Norway
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Weller S, Derntl B, Plewnia C. Sex matters for the enhancement of cognitive training with transcranial direct current stimulation (tDCS). Biol Sex Differ 2023; 14:78. [PMID: 37919761 PMCID: PMC10623760 DOI: 10.1186/s13293-023-00561-4] [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: 07/17/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) can influence brain network activity and associated cognitive and behavioural functions. In addition to the extensive variety in stimulation parameters, numerous biological factors drive these effects, however these are yet poorly understood. Here, we investigate one of the major biological factors by focusing on sex-dependent effects of tDCS on a challenging cognitive control task (adaptive paced auditory serial addition task [PASAT]) in healthy humans. METHODS This sex-specific re-analysis was performed on data of 163 subjects who underwent a 2-week cognitive control training (6 sessions in total). Subjects received either verum (anodal/cathodal) or sham tDCS. Electrodes were placed over the left or right dorsolateral prefrontal cortex and the respective contralateral deltoid muscle. Cognitive control was measured as performance in the PASAT and was analysed in respect to stimulation conditions (sham, anodal, cathodal) and sex. RESULTS Regardless of stimulation condition, performance gains between the sexes were higher in females compared to males (p = 0.0038). Female's performance during anodal tDCS exceeded male's (p = 0.0070), yet no effects were found for cathodal or sham tDCS. Moreover, in females we found a superior effect for anodal tDCS over sham stimulation (fanodal: p = 0.0354; fcathodal: p = 0.6181), but no such effect in males (manodal: p = 0.6882; mcathodal: p = 0.4822). CONCLUSIONS This study highlights the relevance of biological sex for the effects of tDCS on cognitive training. Thus, an increased attention to biological sex is advisable in future brain stimulation research to highlight and in consequence better understand potentially underlying sex-specific mechanisms. Considering biological sex will further advance customisation and individualisation of tDCS interventions. Trial registration ClinicalTrials.gov, NCT04108663.
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Affiliation(s)
- Simone Weller
- Department of Psychiatry and Psychotherapy, Neurophysiology and Interventional Neuropsychiatry, University of Tübingen, Calwerstraße 14, 72076, Tübingen, Germany
- German Center for Mental Health (DZPG), partner site Tübingen, Germany
| | - Birgit Derntl
- German Center for Mental Health (DZPG), partner site Tübingen, Germany
- Department of Psychiatry and Psychotherapy, Innovative Neuroimaging, University of Tübingen, Calwerstraße 14, 72076, Tübingen, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, Neurophysiology and Interventional Neuropsychiatry, University of Tübingen, Calwerstraße 14, 72076, Tübingen, Germany.
- German Center for Mental Health (DZPG), partner site Tübingen, Germany.
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Chen YH, Liang SC, Sun CK, Cheng YS, Tzang RF, Chiu HJ, Wang MY, Cheng YC, Hung KC. A meta-analysis on the therapeutic efficacy of repetitive transcranial magnetic stimulation for cognitive functions in attention-deficit/hyperactivity disorders. BMC Psychiatry 2023; 23:756. [PMID: 37845676 PMCID: PMC10580630 DOI: 10.1186/s12888-023-05261-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Therapeutic efficacies of repetitive transcranial magnetic stimulation (rTMS) for improving cognitive functions in patients with deficit/hyperactivity disorder (ADHD) remained unclear. The aim of this meta-analysis was to investigate the therapeutic efficacy of rTMS focusing on different cognitive performances. METHODS Major databases were searched electronically from inception to February 2023 by using keywords mainly "rTMS" and "ADHD" to identify randomized controlled trials (RCTs) that investigated the therapeutic efficacy of rTMS for improving cognitive functions assessed by standardized tasks in patients with ADHD. The overall effect size (ES) was calculated as standardized mean difference (SMD) based on a random effects model. RESULTS Meta-analysis of five RCTs with 189 participants (mean age of 32.78 and 8.53 years in adult and child/adolescent populations, respectively) demonstrated that rTMS was more effective for improving sustained attention in patients with ADHD compared with the control groups (SMD = 0.54, p = 0.001).Our secondary analysis also showed that rTMS was more effective for improving processing speed than the control groups (SMD = 0.59, p = 0.002) but not for enhancing memory or executive function. CONCLUSIONS Our results supported the therapeutic efficacy of rTMS for improving sustained attention and processing speed. However, the limitation of available data warrants further studies to verify these findings.
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Affiliation(s)
- Ying-Hsin Chen
- Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Shun-Chin Liang
- Department of Management Center, Jianan Psychiatric Center, Ministry Of Health and Welfare, Tainan, Taiwan
- Department of Center for General Education, University of Kun Shan, Tainan, Taiwan
- Department of Optometry, University of Chung Hwa of Medical Technology, Tainan, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Yu-Shian Cheng
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung City, Taiwan
| | - Ruu-Fen Tzang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Hsien-Jane Chiu
- Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan City, Taiwan
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei City, Taiwan
| | - Ming-Yu Wang
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Ying-Chih Cheng
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.
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Weinberg H, Baruch Y, Tzameret H, Lavidor M. Cognitive control enhancement in attention deficit hyperactivity disorder (ADHD) and neurotypical individuals. Exp Brain Res 2023; 241:2381-2392. [PMID: 37624418 DOI: 10.1007/s00221-023-06695-6] [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: 05/20/2023] [Accepted: 08/22/2023] [Indexed: 08/26/2023]
Abstract
Cognitive control, which has been localized to the right inferior frontal gyrus (rIFG) based on functional imaging and brain lesion studies, is impaired in patients with ADHD. The present study aims to investigate whether transcranial direct current stimulation (tDCS) over the rIFG might improve cognitive control in ADHD subjects. We hypothesized poorer performance in a cognitive control task, but not in a control language task, in the ADHD subjects. Crucially, following tDCS, we expected the ADHD group to improve their cognitive control. In a double-blind randomized control trial, 42 participants performed the stop signal task (SST) to index their cognitive control level and the language task. Half of them were randomly assigned to the anodal stimulation condition and half to the sham stimulation. The anodal or sham stimulation was applied over the right IFG. Following the stimulation, the participants reset the two tasks to see whether stimulation improved the (predicted) weaker performance in the ADHD group. Stimulation significantly enhanced cognitive control for both groups, with or without ADHD, in the SST task, but no significant stimulation effects were found for the control task. tDCS seems as a promising tool to improve cognitive control in the general population.
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Affiliation(s)
- Hodaya Weinberg
- The Gonda Brain Research Center and Psychology Department, Bar Ilan University, Ramat Gan, Israel
| | - Yuval Baruch
- The Gonda Brain Research Center and Psychology Department, Bar Ilan University, Ramat Gan, Israel
| | - Hila Tzameret
- The Gonda Brain Research Center and Psychology Department, Bar Ilan University, Ramat Gan, Israel
| | - Michal Lavidor
- The Gonda Brain Research Center and Psychology Department, Bar Ilan University, Ramat Gan, Israel.
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15
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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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16
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Klees-Themens G, Théoret H. The effects of transcranial direct current stimulation on corticospinal excitability: A systematic review of nonsignificant findings. Eur J Neurosci 2023; 58:3074-3097. [PMID: 37407275 DOI: 10.1111/ejn.16073] [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: 11/14/2022] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that can modulate brain activity through the application of low-intensity electrical currents. Based on its reported effects on corticospinal excitability (CSE), tDCS has been used to study cognition in healthy individuals and reduce symptoms in a variety of clinical conditions. Despite its increasing popularity as a research and clinical tool, high interindividual variability has been reported in the response to protocols using transcranial magnetic stimulation (TMS) to assess tDCS-induced changes in CSE leading to several nonsignificant findings. In this systematic review, studies that reported no significant modulation of CSE following tDCS were identified from PubMed and Embase (Ovid) databases. Forty-three articles were identified where demographic, TMS and tDCS parameters were extracted. Overall, stimulation parameters, CSE measurements and participant characteristics were similar to those described in studies reporting positive results and were likewise heterogeneous between studies. Small sample sizes and inadequate blinding were notable features of the reviewed studies. This systematic review suggests that studies reporting nonsignificant findings do not markedly differ from those reporting significant modulation of CSE.
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Affiliation(s)
| | - Hugo Théoret
- Department of Psychology, Université de Montréal, Montreal, Québec, Canada
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17
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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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Dagnino PC, Braboszcz C, Kroupi E, Splittgerber M, Brauer H, Dempfle A, Breitling-Ziegler C, Prehn-Kristensen A, Krauel K, Siniatchkin M, Moliadze V, Soria-Frisch A. Stratification of responses to tDCS intervention in a healthy pediatric population based on resting-state EEG profiles. Sci Rep 2023; 13:8438. [PMID: 37231030 DOI: 10.1038/s41598-023-34724-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/06/2023] [Indexed: 05/27/2023] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulation technique with a wide variety of clinical and research applications. As increasingly acknowledged, its effectiveness is subject dependent, which may lead to time consuming and cost ineffective treatment development phases. We propose the combination of electroencephalography (EEG) and unsupervised learning for the stratification and prediction of individual responses to tDCS. A randomized, sham-controlled, double-blind crossover study design was conducted within a clinical trial for the development of pediatric treatments based on tDCS. The tDCS stimulation (sham and active) was applied either in the left dorsolateral prefrontal cortex or in the right inferior frontal gyrus. Following the stimulation session, participants performed 3 cognitive tasks to assess the response to the intervention: the Flanker Task, N-Back Task and Continuous Performance Test (CPT). We used data from 56 healthy children and adolescents to implement an unsupervised clustering approach that stratify participants based on their resting-state EEG spectral features before the tDCS intervention. We then applied a correlational analysis to characterize the clusters of EEG profiles in terms of participant's difference in the behavioral outcome (accuracy and response time) of the cognitive tasks when performed after a tDCS-sham or a tDCS-active session. Better behavioral performance following the active tDCS session compared to the sham tDCS session is considered a positive intervention response, whilst the reverse is considered a negative one. Optimal results in terms of validity measures was obtained for 4 clusters. These results show that specific EEG-based digital phenotypes can be associated to particular responses. While one cluster presents neurotypical EEG activity, the remaining clusters present non-typical EEG characteristics, which seem to be associated with a positive response. Findings suggest that unsupervised machine learning can be successfully used to stratify and eventually predict responses of individuals to a tDCS treatment.
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Affiliation(s)
| | - Claire Braboszcz
- Neuroscience BU, Starlab Barcelona SL, Av Tibidabo 47 bis, Barcelona, Spain
| | - Eleni Kroupi
- Neuroscience BU, Starlab Barcelona SL, Av Tibidabo 47 bis, Barcelona, Spain
| | - Maike Splittgerber
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Hannah Brauer
- Department of Child and Adolescent Psychiatry, Center for Integrative Psychiatry Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, University Hospital Schleswig Holstein, Kiel University, Kiel, Germany
| | - Carolin Breitling-Ziegler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Alexander Prehn-Kristensen
- Department of Child and Adolescent Psychiatry, Center for Integrative Psychiatry Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Kerstin Krauel
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Michael Siniatchkin
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, University of Bielefeld, Campus Bielefeld Bethel, Bielefeld, Germany
| | - Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Aureli Soria-Frisch
- Neuroscience BU, Starlab Barcelona SL, Av Tibidabo 47 bis, Barcelona, Spain.
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Oguchi M, Takahashi T, Nitta Y, Kumano H. Moderating effect of attention deficit hyperactivity disorder tendency on the relationship between delay discounting and procrastination in young adulthood. Heliyon 2023; 9:e14834. [PMID: 37025860 PMCID: PMC10070913 DOI: 10.1016/j.heliyon.2023.e14834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Among adults with ADHD, one of the most common problems in daily life is procrastination. ADHD is characterized by attention as well as suboptimal decision-making deficits, indicating difficulty in making long-term reward choices. However, little is known about the relationship between suboptimal decision-making or temporal discounting (TD) and procrastination among adults with ADHD. This study aimed to investigate whether ADHD symptoms enhance the relationship between TD and procrastination. Fifty-eight university participants completed questionnaires about procrastination and an experimental task which measured TD rates in reward and punishment conditions. Only the reward condition showed that ADHD symptoms significantly strengthened the association between the TD rate and procrastination. This study revealed that even when ADHD symptoms were high, higher TD rates were associated with more procrastination, while lower TD rates were associated with less procrastination. The results suggest that procrastination interventions for adult ADHD-prone individuals need to pay attention to reward responses.
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Peng L, Tian L, Wang T, Wang Q, Li N, Zhou H. Effects of non-invasive brain stimulation (NIBS) for executive function on subjects with ADHD: a protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e069004. [PMID: 36878663 PMCID: PMC9990641 DOI: 10.1136/bmjopen-2022-069004] [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: 10/10/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder with a high risk of multiple mental health and social difficulties. Executive function domains are associated with distinct ADHD symptom burdens. Non-invasive brain stimulation (NIBS) mainly includes repetitive transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), which is a promising technique, but its impact on the executive function of ADHD is uncertain. Therefore, the aim of this systematic review and meta-analysis is to derive solid and updated estimates on the effect of NIBS on executive function in children/adults with ADHD. METHODS AND ANALYSIS A systematic search will be performed through EMBASE, MEDLINE, PsycINFO and Web of Science databases from inception until 22 August 2022. Handsearching of grey literature and the reference lists of selected articles will also be conducted. Empirical studies assessing the effect of NIBS (TMS or tDCS) on executive function in children or adults with ADHD will be included. Two investigators will independently perform literature identification, data extraction and risk of bias assessment. Relevant data will be pooled by a fixed-effects or random-effects model according to I2 statistic. Sensitivity analysis will be performed to test the robustness of the pooled estimates. Subgroup analyses will be conducted to investigate the potential heterogeneity. This protocol will generate a systematic review and meta-analysis that comprehensively synthesises the evidence on the NIBS treatment of executive function deficit of ADHD.Ethics approval is not required as this is a protocol for a systematic review of published literature. The results will be submitted to a peer-reviewed journal or a conference. PROSPERO REGISTRATION NUMBER CRD42022356476.
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Affiliation(s)
- Lihong Peng
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liyan Tian
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tiantian Wang
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiu Wang
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na Li
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui Zhou
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Wang YC, Liu J, Wu YC, Wei Y, Xie HJ, Zhang T, Zhang Z. A randomized, sham-controlled trial of high-definition transcranial direct current stimulation on the right orbital frontal cortex in children and adolescents with attention-deficit hyperactivity disorder. Front Psychiatry 2023; 14:987093. [PMID: 36860502 PMCID: PMC9968859 DOI: 10.3389/fpsyt.2023.987093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/13/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE This study aimed to find out the clinical and cognitive effects of high-definition transcranial direct current stimulation (HD-tDCS) on the right orbital frontal cortex (OFC) in the treatment of attention deficit hyperactivity disorder (ADHD). METHODS A total of 56 patients with ADHD were recruited as subjects and completely and randomly divided into the HD-tDCS group and the Sham group. A 1.0 mA anode current was applied to the right OFC. The HD-tDCS group received real stimulation, while the Sham group received sham stimulation in 10 sessions of treatment. ADHD symptom assessment (the SNAP-IV Rating Scale and the Perceived Stress Questionnaire) was carried out before treatment, after the 5th and 10th stimuli, and at the 6th week after the end of all stimulations, while the cognitive effect was assessed by the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), the Stroop Color and Word Test (Stroop), and the Tower of Hanoi (TOH). Repeated-measure ANOVA was used to find out the results of both groups before and after treatment. RESULTS A total of 47 patients completed all sessions and evaluations. Their SNAP-IV score, their PSQ score, the mean visual and auditory reaction times by IVA-CPT, the interference RT of Stroop Color and Word, and the number of completed steps of TOH did not change with intervention time before and after treatment (P > 0.0031). However, the integrated visual and audiovisual commission errors and the TOH completion time results of the HD-tDCS group were significantly decreased after the 5th intervention, the 10th intervention, and the 6th week of intervention follow-up compared to the Sham group (P < 0.0031). CONCLUSION This study draws cautious conclusions that HD-tDCS does not significantly alleviate the overall symptoms of patients with ADHD but leads to significant improvements in the cognitive measures of attention maintenance. The study also attempted to fill in the gaps in research studies on HD-tDCS stimulation of the right OFC. CLINICAL TRIAL REGISTRATION ChiCTR2200062616.
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Affiliation(s)
- Yi-Chao Wang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Zhenjiang Mental Health Center (The Fifth People's Hospital of Zhenjiang City), Zhenjiang, Jiangsu, China
| | - Jun Liu
- Zhenjiang Mental Health Center (The Fifth People's Hospital of Zhenjiang City), Zhenjiang, Jiangsu, China
| | - Yan-Chun Wu
- Zhenjiang Mental Health Center (The Fifth People's Hospital of Zhenjiang City), Zhenjiang, Jiangsu, China
| | - Yan Wei
- Zhenjiang Mental Health Center (The Fifth People's Hospital of Zhenjiang City), Zhenjiang, Jiangsu, China
| | - Hong-Jing Xie
- Zhenjiang Mental Health Center (The Fifth People's Hospital of Zhenjiang City), Zhenjiang, Jiangsu, China
| | - Tao Zhang
- Zhenjiang Mental Health Center (The Fifth People's Hospital of Zhenjiang City), Zhenjiang, Jiangsu, China
| | - Zhen Zhang
- Zhenjiang Mental Health Center (The Fifth People's Hospital of Zhenjiang City), Zhenjiang, Jiangsu, China
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22
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Luo L, You W, DelBello MP, Gong Q, Li F. Recent advances in psychoradiology. Phys Med Biol 2022; 67. [PMID: 36279868 DOI: 10.1088/1361-6560/ac9d1e] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/24/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Psychiatry, as a field, lacks objective markers for diagnosis, progression, treatment planning, and prognosis, in part due to difficulties studying the brain in vivo, and diagnoses are based on self-reported symptoms and observation of patient behavior and cognition. Rapid advances in brain imaging techniques allow clinical investigators to noninvasively quantify brain features at the structural, functional, and molecular levels. Psychoradiology is an emerging discipline at the intersection of psychiatry and radiology. Psychoradiology applies medical imaging technologies to psychiatry and promises not only to improve insight into structural and functional brain abnormalities in patients with psychiatric disorders but also to have potential clinical utility. We searched for representative studies related to recent advances in psychoradiology through May 1, 2022, and conducted a selective review of 165 references, including 75 research articles. We summarize the novel dynamic imaging processing methods to model brain networks and present imaging genetics studies that reveal the relationship between various neuroimaging endophenotypes and genetic markers in psychiatric disorders. Furthermore, we survey recent advances in psychoradiology, with a focus on future psychiatric diagnostic approaches with dimensional analysis and a shift from group-level to individualized analysis. Finally, we examine the application of machine learning in psychoradiology studies and the potential of a novel option for brain stimulation treatment based on psychoradiological findings in precision medicine. Here, we provide a summary of recent advances in psychoradiology research, and we hope this review will help guide the practice of psychoradiology in the scientific and clinical fields.
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23
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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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24
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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: 20] [Impact Index Per Article: 10.0] [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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25
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Salehinejad MA, Ghanavati E, Glinski B, Hallajian AH, Azarkolah A. A systematic review of randomized controlled trials on efficacy and safety of transcranial direct current stimulation in major neurodevelopmental disorders: ADHD, autism, and dyslexia. Brain Behav 2022; 12:e2724. [PMID: 35938945 PMCID: PMC9480913 DOI: 10.1002/brb3.2724] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/09/2022] [Accepted: 07/12/2022] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Among the target groups in child and adolescent psychiatry, transcranial direct current stimulation (tDCS) has been more applied in neurodevelopmental disorders specifically, attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and dyslexia. This systematic review aims to provide the latest update on published randomized-controlled trials applying tDCS in these disorders for evaluating its efficacy and safety. METHODS Based on a pre-registered protocol (PROSPERO: CRD42022321430) and using the PRISMA approach, a literature search identified 35 randomized controlled trials investigating the effects of tDCS on children and adolescents with ADHD (n = 17), ASD (n = 11), and dyslexia (n = 7). RESULTS In ADHD, prefrontal anodal tDCS is reported more effective compared to stimulation of the right inferior frontal gyrus. Similarly in ASD, prefrontal anodal tDCS was found effective for improving behavioral problems. In dyslexia, stimulating temporoparietal regions was the most common and effective protocol. In ASD and dyslexia, all tDCS studies found an improvement in at least one of the outcome variables while 64.7% of studies (11 of 17) in ADHD found a similar effect. About 88% of all tDCS studies with a multi-session design in 3 disorders (16 of 18) reported a significant improvement in one or all outcome variables after the intervention. Randomized, double-blind, controlled trials consisted of around 70.5%, 36.3%, and 57.1% of tDCS studies in ADHD, ASD, and dyslexia, respectively. tDCS was found safe with no reported serious side effects in 6587 sessions conducted on 745 children and adolescents across 35 studies. CONCLUSION tDCS was found safe and partially effective. For evaluation of clinical utility, larger randomized controlled trials with a double-blind design and follow-up measurements are required. Titration studies that systematically evaluate different stimulation intensities, duration, and electrode placement are lacking.
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Affiliation(s)
- Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Elham Ghanavati
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Benedikt Glinski
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Psychology, Ruhr-University Bochum, Bochum, Germany
| | | | - Anita Azarkolah
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Atieh Clinical Neuroscience Center, Tehran, Iran
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26
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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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27
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Dakwar-Kawar O, Berger I, Barzilay S, Grossman ES, Cohen Kadosh R, Nahum M. Examining the Effect of Transcranial Electrical Stimulation and Cognitive Training on Processing Speed in Pediatric Attention Deficit Hyperactivity Disorder: A Pilot Study. Front Hum Neurosci 2022; 16:791478. [PMID: 35966992 PMCID: PMC9363890 DOI: 10.3389/fnhum.2022.791478] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveProcessing Speed (PS), the ability to perceive and react fast to stimuli in the environment, has been shown to be impaired in children with attention deficit hyperactivity disorder (ADHD). However, it is unclear whether PS can be improved following targeted treatments for ADHD. Here we examined potential changes in PS following application of transcranial electric stimulation (tES) combined with cognitive training (CT) in children with ADHD. Specifically, we examined changes in PS in the presence of different conditions of mental fatigue.MethodsWe used a randomized double-blind active-controlled crossover study of 19 unmedicated children with ADHD. Participants received either anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (dlPFC) or transcranial random noise stimulation (tRNS), while completing CT, and the administration order was counterbalanced. PS was assessed before and after treatment using the MOXO-CPT, which measures PS in the presence of various conditions of mental fatigue and cognitive load.ResultstRNS combined with CT yielded larger improvements in PS compared to tDCS combined with CT, mainly under condition of increased mental fatigue. Further improvements in PS were also seen in a 1-week follow up testing.ConclusionThis study provides initial support for the efficacy of tRNS combined with CT in improving PS in the presence of mental fatigue in pediatric ADHD.
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Affiliation(s)
- Ornella Dakwar-Kawar
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Itai Berger
- Pediatric Neurology, Assuta-Ashdod University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- Paul Baerwald School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel
| | - Snir Barzilay
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ephraim S. Grossman
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roi Cohen Kadosh
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- *Correspondence: Mor Nahum,
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28
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Blinding efficacy and adverse events following repeated transcranial alternating current, direct current, and random noise stimulation. Cortex 2022; 154:77-88. [PMID: 35759817 DOI: 10.1016/j.cortex.2022.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 04/10/2022] [Accepted: 05/03/2022] [Indexed: 11/22/2022]
Abstract
As transcranial electrical stimulation (tES) protocols advance, assumptions underlying the technique need to be retested to ensure they still hold. Whilst the safety of stimulation has been demonstrated mainly for a small number of sessions, and small sample size, adverse events (AEs) following multiple sessions remain largely untested. Similarly, whilst blinding procedures are typically assumed to be effective, the effect of multiple stimulation sessions on the efficacy of blinding procedures also remains under question. This is especially relevant in multisite projects where small unintentional variations in protocol could lead to inter-site difference. We report AE and blinding data from 1,019 participants who received up to 11 semi-consecutive sessions of active or sham transcranial alternating current stimulation (tACS), direct current stimulation (tDCS), and random noise stimulation (tRNS), at 4 sites in the UK and US. We found that AEs were often best predicted by factors other than tES, such as testing site or session number. Results from the blinding analysis suggested that blinding was less effective for tDCS and tACS than tRNS. The occurrence of AEs did not appear to be linked to tES despite the use of smaller electrodes or repeated delivery. However, blinding efficacy was impacted in tES conditions with higher cutaneous sensation, highlighting a need for alternative stimulation blinding protocols. This may be increasingly necessary in studies wishing to deliver stimulation with higher intensities.
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29
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Rubia K. Neurotherapeutics for ADHD: Do they work? Psych J 2022; 11:419-427. [PMID: 35359026 PMCID: PMC10083951 DOI: 10.1002/pchj.544] [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: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/08/2022]
Abstract
This paper reflects on the use of neurotherapeutics for attention-deficit/hyperactivity disorder (ADHD). ADHD is the most imaged child psychiatric disorder, with over 3 decades of magnetic resonance imaging (MRI) research. Findings are relatively homogeneous compared to other psychiatric conditions with consistent evidence for differences, albeit small, relative to healthy controls in the structure and function of several frontal, parietotemporal, and striatal brain regions as well as their inter-regional structural and functional connections. The functional deficits have been targeted with modern neurotherapeutics, including neurofeedback (using most commonly electroencephalography and more recently functional near-infrared spectroscopy and functional MRI) and non-invasive brain stimulation (such as repetitive transcranial magnetic stimulation, transcranial direct current stimulation, or external trigeminal nerve stimulation). Except for electroencephalography-neurofeedback, the majority of neurotherapeutic studies have been relatively small, with very heterogenous research protocols and outcome measures and-likely as a consequence-inconsistent findings. Furthermore, most brain stimulation studies have tested effects on cognitive functions rather than clinical symptoms. So far, findings have not been very promising. Future studies require systematic testing of optimal protocols in large samples or homogenous subgroups to understand response prediction that could lead to individualized treatment.
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Affiliation(s)
- Katya Rubia
- Department of Child & Adolescent Psychiatry/PO46, Institute of Psychiatry, Psychology & NeurosciencesKing's College LondonLondonUK
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30
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Westwood SJ, Bozhilova N, Criaud M, Lam SL, Lukito S, Wallace-Hanlon S, Kowalczyk OS, Kostara A, Mathew J, Wexler BE, Kadosh RC, Asherson P, Rubia K. The effect of transcranial direct current stimulation (tDCS) combined with cognitive training on EEG spectral power in adolescent boys with ADHD: A double-blind, randomized, sham-controlled trial. IBRO Neurosci Rep 2022; 12:55-64. [PMID: 35746969 PMCID: PMC9210460 DOI: 10.1016/j.ibneur.2021.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/19/2021] [Indexed: 12/19/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a possible alternative to psychostimulants in Attention-Deficit/Hyperactivity Disorder (ADHD), but its mechanisms of action in children and adolescents with ADHD are poorly understood. We conducted the first 15-session, sham-controlled study of anodal tDCS over right inferior frontal cortex (rIFC) combined with cognitive training (CT) in 50 children/adolescents with ADHD. We investigated the mechanisms of action on resting and Go/No-Go Task-based QEEG measures in a subgroup of 23 participants with ADHD (n, sham = 10; anodal tDCS = 13). We failed to find a significant sham versus anodal tDCS group differences in QEEG spectral power during rest and Go/No-Go Task performance, a correlation between QEEG and Go/No-Go Task performance, and changes in clinical and cognitive measures. These findings extend the non-significant clinical and cognitive effects in our sample of 50 children/adolescents with ADHD. Given that the subgroup of 23 participants would have been underpowered, the interpretation of our findings is limited and should be used as a foundation for future investigations. Larger, adequately powered randomized controlled trials should explore different protocols titrated to the individual and using comprehensive measures to assess cognitive, clinical, and neural effects of tDCS and its underlying mechanisms of action in ADHD.
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Affiliation(s)
- Samuel J. Westwood
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- School of Psychology, University of Wolverhampton, Wolverhampton WV1 1LY UK
- Department of Psychology, School of Social Science, University of Westminster, London W1W 6UW, UK
| | - Natali Bozhilova
- Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- School of Psychology, University of Surrey, Guildford GU2 7XH, UK
| | - Marion Criaud
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Sheut-Ling Lam
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Steve Lukito
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Sophie Wallace-Hanlon
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- School of Psychology, University of Surrey, Guildford GU2 7XH, UK
| | - Olivia S. Kowalczyk
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Afroditi Kostara
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Joseph Mathew
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Bruce E. Wexler
- Department of Psychiatry, Yale University School of Medicine, 06520–8096, USA
| | - Roi Cohen Kadosh
- School of Psychology, University of Surrey, Guildford GU2 7XH, UK
| | - Philip Asherson
- Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
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31
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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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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: 27] [Impact Index Per Article: 13.5] [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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Yokokura M, Takebasashi K, Takao A, Nakaizumi K, Yoshikawa E, Futatsubashi M, Suzuki K, Nakamura K, Yamasue H, Ouchi Y. In vivo imaging of dopamine D1 receptor and activated microglia in attention-deficit/hyperactivity disorder: a positron emission tomography study. Mol Psychiatry 2021; 26:4958-4967. [PMID: 32439845 DOI: 10.1038/s41380-020-0784-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
Abstract
Alterations in the cortical dopamine system and microglial activation have been implicated in the pathophysiology of attention-deficit/hyperactivity disorder (ADHD), one of neurodevelopmental disorders that can be conventionally treated with a dopamine enhancer (methylphenidate) albeit unsatisfactorily. Here, we investigated the contributions of the dopamine D1 receptor (D1R) and activated microglia and their interactions to the clinical severities in ADHD individuals using positron emission tomography (PET). Twenty-four psychotropic-naïve ADHD individuals and 24 age- and sex-matched typically developing (TD) subjects underwent PET measurements with [11C]SCH23390 for the D1R and [11C](R)PK11195 for activated microglia as well as assessments of clinical symptoms and cognitive functions. The ADHD individuals showed decreased D1R in the anterior cingulate cortex (ACC) and increased activated microglia in the dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC) compared with the TD subjects. The decreased D1R in the ACC was associated with severe hyperactivity in the participants with ADHD. Microglial activation in the DLPFC were associated with deficits in processing speed and attentional ability, and that in the OFC was correlated with lower processing speed in the ADHD individuals. Furthermore, positive correlations between the D1R and activated microglia in both the DLPFC and the OFC were found to be significantly specific to the ADHD group and not to the TD group. The current findings suggest that microglial activation and the D1R reduction as well as their aberrant interactions underpin the neurophysiological mechanism of ADHD and indicate these biomolecular changes as a novel therapeutic target.
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Affiliation(s)
- Masamichi Yokokura
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kiyokazu Takebasashi
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Kyoko Nakaizumi
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Etsuji Yoshikawa
- Central Research Laboratory, Hamamatsu Photonics K.K, Hamamatsu, Japan
| | - Masami Futatsubashi
- Global Strategic Challenge Center, Hamamatsu Photonics K.K, Hamamatsu, Japan.,Hamamatsu PET Imaging Center, Hamamatsu Medical Photonics Foundation, Hamamatsu, Japan
| | - Katsuaki Suzuki
- Department of Biofunctional Imaging, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Hidenori Yamasue
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuomi Ouchi
- Department of Biofunctional Imaging, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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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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Rubia K, Westwood S, Aggensteiner PM, Brandeis D. Neurotherapeutics for Attention Deficit/Hyperactivity Disorder (ADHD): A Review. Cells 2021; 10:2156. [PMID: 34440925 PMCID: PMC8394071 DOI: 10.3390/cells10082156] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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
| | - 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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García-González S, Lugo-Marín J, Setien-Ramos I, Gisbert-Gustemps L, Arteaga-Henríquez G, Díez-Villoria E, Ramos-Quiroga JA. Transcranial direct current stimulation in Autism Spectrum Disorder: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2021; 48:89-109. [PMID: 33773886 DOI: 10.1016/j.euroneuro.2021.02.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has gained relevance in recent years as an alternative treatment for neuropsychiatric conditions. The aim of this study is to conduct a systematic review of the use of tDCS in Autism Spectrum Disorder (ASD). Both electronic and manual searches were conducted to identify studies published in peer-reviewed scientific journals addressing the use of tDCS in ASD population. A total of 16 studies fulfilled the criteria to be included in the review. Studies were conducted both in child and adult population. Anodal stimulation on the left dorsolateral prefrontal cortex was the most commonly chosen methodology. Outcomes addressed ASD symptoms and neuropsychological functions. Meta-analytic synthesis identified improvements in social, health, and behavioral problem domains of the Autism Treatment Evaluation Checklist. Limitations included high heterogeneity in the methodology and low-efficacy study designs (pre-post and single-case studies). Recent controlled trials shed promising results for the use of tDCS in ASD. A standardized stimulation protocol and a consensus in the measures used in the evaluation of the efficacy are imperative.
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Affiliation(s)
- Sara García-González
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Jorge Lugo-Marín
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Imanol Setien-Ramos
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Laura Gisbert-Gustemps
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gara Arteaga-Henríquez
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Emiliano Díez-Villoria
- Centro de Atención Integral al Autismo-InFoAutismo, INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca, Salamanca, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain.
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38
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Chen G, Zhu Z, He Q, Fang F. Offline transcranial direct current stimulation improves the ability to perceive crowded targets. J Vis 2021; 21:1. [PMID: 33533878 PMCID: PMC7862736 DOI: 10.1167/jov.21.2.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The deleterious effect of nearby flankers on target identification in the periphery is known as visual crowding. Studying visual crowding can advance our understanding of the mechanisms of visual awareness and object recognition. Alleviating visual crowding is one of the major ways to improve peripheral vision. The aim of the current study was to examine whether transcranial direct current stimulation (tDCS) was capable of alleviating visual crowding at different visual eccentricities and with different visual tasks. In the present single-blind sham-controlled study, subjects were instructed to perform an orientation discrimination task or a letter identification task with isolated and crowded targets in the periphery, before and after applying 20 minutes of 2 mA anodal tDCS to visual cortex of the hemisphere contralateral or ipsilateral to visual stimuli. Contralateral tDCS significantly alleviated the orientation crowding effect at two different eccentricities and the letter crowding effect. This alleviation was absent after sham or ipsilateral stimulation and could not be fully explained by the performance improvement with the isolated targets. These findings demonstrated that offline tDCS was effective in alleviating visual crowding across different visual eccentricities and tasks, therefore providing a promising way to improve spatial vision rapidly in crowded scenes.
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Affiliation(s)
- Guanpeng Chen
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, People's Republic of China.,IDG/McGovern Institute for Brain Research, Peking University, Beijing, People's Republic of China.,Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, People's Republic of China.,
| | - Ziyun Zhu
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, People's Republic of China.,IDG/McGovern Institute for Brain Research, Peking University, Beijing, People's Republic of China.,Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, People's Republic of China.,
| | - Qing He
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, People's Republic of China.,IDG/McGovern Institute for Brain Research, Peking University, Beijing, People's Republic of China.,Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, People's Republic of China.,
| | - Fang Fang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, People's Republic of China.,IDG/McGovern Institute for Brain Research, Peking University, Beijing, People's Republic of China.,Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, People's Republic of China.,
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39
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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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Salehinejad MA, Paknia N, Hosseinpour AH, Yavari F, Vicario CM, Nitsche MA, Nejati V. Contribution of the right temporoparietal junction and ventromedial prefrontal cortex to theory of mind in autism: A randomized, sham-controlled tDCS study. Autism Res 2021; 14:1572-1584. [PMID: 34018333 DOI: 10.1002/aur.2538] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/28/2021] [Accepted: 04/20/2021] [Indexed: 12/29/2022]
Abstract
Theory of mind (ToM) is the ability to attribute subjective mental states to oneself and others and is significantly impaired in autism spectrum disorder (ASD). A frontal-posterior network of regions including the ventromedial prefrontal cortex (vmPFC) and temporoparietal junction (TPJ) is involved in ToM. Previous studies show an underactivation of these regions in ASD. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation method for causally investigating brain-behavior relationships via induction of cortical excitability alterations. tDCS, mostly over the dorsolateral prefrontal cortex, has been increasingly applied for improving behavioral problems in ASD leaving other potentially interesting regions untouched. Here we investigated contribution of the vmPFC and right TPJ in ToM abilities of ASD children via tDCS in a pilot study. Sixteen children with ASD (mean age = 10.7 ± 1.9) underwent three tDCS sessions (1 mA, 20 min) in a randomized, sham-controlled design. Stimulation protocols included: (a) anodal vmPFC tDCS, (b) anodal r-TPJ tDCS, and (c) sham tDCS. ToM abilities were explored during tDCS using the theory of mind test (TOMT). Our results show that activation of the vmPFC with anodal tDCS significantly improved ToM in children with ASD compared with both, r-TPJ tDCS, and sham stimulation. Specifically, precursors of ToM (e.g., emotion recognition, perception, and imitation) and elementary ToM skills (e.g., first-order mental state reasoning) were significantly improved by anodal vmPFC tDCS. Based on these results, the vmPFC could be a potential target region for the reduction of ASD symptoms via noninvasive brain stimulation, which should be examined in larger detail in future studies. LAY SUMMARY: Theory of mind (ToM) is the ability to infer mental states of oneself and others, which is impaired in autism. Brain imaging studies have shown involvement of two brain regions in ToM (ventromedial prefrontal cortex, temporoparietal junction) which are underactivated in autism. We increased activation of these regions via noninvasive brain stimulation in this experiment to see how it would affect ToM abilities in autism. We found that increased activation of the ventromedial prefrontal cortex improved ToM abilities in children with autism.
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Affiliation(s)
- Mohammad Ali Salehinejad
- Leibniz Research Centre for Working Environment and Human Factors, Department of Psychology and Neurosciences, Dortmund, Germany
| | - Nasim Paknia
- Department of Rehabilitation Counseling, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Amir Hossein Hosseinpour
- Department of Rehabilitation Counseling, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Fatemeh Yavari
- Leibniz Research Centre for Working Environment and Human Factors, Department of Psychology and Neurosciences, Dortmund, Germany
| | - Carmelo M Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Universita' di Messina, Messina, Italy
| | - 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
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
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Nejati V, Movahed Alavi M, Nitsche MA. The Impact of Attention Deficit-hyperactivity Disorder Symptom Severity on the Effectiveness of Transcranial Direct Current Stimulation (tDCS) on Inhibitory Control. Neuroscience 2021; 466:248-257. [PMID: 34015371 DOI: 10.1016/j.neuroscience.2021.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 12/26/2022]
Abstract
The present study aimed to assess the impact of transcranial direct current stimulation (tDCS) on different domains of inhibitory control in children with mild or severe ADHD symptoms. Twenty-four children with ADHD, in two groups with severe and mild symptoms, received anodal or sham tDCS over the right dorsolateral prefrontal cortex (dlPFC) during performing inhibitory control tasks. A significant main effect of stimulation condition was found that was limited to the circle tracing task, and the incongruent condition of the flanker task. Moreover, the main effects of stimulation condition and group were non-significant, but their interaction was significant for No-Go accuracy. The results suggest that the right dlPFC has a crucial role in ongoing inhibition in children with ADHD, and that tDCS has a partially symptom severity-dependent effect on inhibitory control. These findings are discussed in connection with severity-dependent psychopathology.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, 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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Bleich-Cohen M, Gurevitch G, Carmi N, Medvedovsky M, Bregman N, Nevler N, Elman K, Ginou A, Zangen A, Ash EL. A functional magnetic resonance imaging investigation of prefrontal cortex deep transcranial magnetic stimulation efficacy in adults with attention deficit/hyperactive disorder: A double blind, randomized clinical trial. Neuroimage Clin 2021; 30:102670. [PMID: 34215144 PMCID: PMC8102620 DOI: 10.1016/j.nicl.2021.102670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/19/2021] [Accepted: 04/08/2021] [Indexed: 02/09/2023]
Abstract
ADHD is one of the most prevalent neurocognitive disorders. Deep Transcranial Magnetic Stimulation (dTMS) is a non-invasive neuromodulation tool that holds promise in treatment of neurocognitive disorders. Hypoactivity of the prefrontal cortex (PFC) has been observed in ADHD. This study examined the clinical, cognitive, and neural effects of dTMS to the PFC in adults with ADHD by using functional magnetic resonance imaging (fMRI). High frequency repetitive dTMS was applied to either the right or left PFC in 62 adults with ADHD in a randomized, double blind, placebo controlled protocol with 3 study groups: 2 treatment arms (rPFC, or lPFC) and a Sham arm. The study included 15 dTMS/cognitive training treatment sessions. Clinical effects were assessed with the Conners Adult ADHD Rating Scale (CAARS) self-report and the Clinical Global Impression score (CGI) as primary outcome measures. Self-report/observer questionnaires and computerized cognitive testing were also performed to assess clinical and cognitive effects. Neural effects were assessed with fMRI using working-memory (WM) and resting-state paradigms. While the study did not show improvement in the primary endpoints, significant improvements were observed in the CAARS (self-report) inattention/memory sub-scale, as well as increased activations in the rDLPFC, right parietal-cortex and right insula/IFG during WM conditions after treatment in the right stimulation group. Increased rDLPFC activation was associated with larger symptom improvement in the right stimulation group. This study indicates that dTMS is effective in modulating attention related brain networks, and is a feasible technique that may improve attention symptoms in adults with ADHD.
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Affiliation(s)
- Maya Bleich-Cohen
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; Brainsway Ltd, Jerusalem 9777518, Israel.
| | - Guy Gurevitch
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Noa Carmi
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Mordekhay Medvedovsky
- Department of Neurology, Agnes Ginges Center of Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Noa Bregman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Naomi Nevler
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Karin Elman
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Amit Ginou
- Brainsway Ltd, Jerusalem 9777518, Israel
| | - Abraham Zangen
- Brain Stimulation and Behavior Lab, The Zlotowski Center for Neuroscience, Ben Gurion University, Beer Sheva 8410501, Israel
| | - Elissa L Ash
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
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Marković V, Vicario CM, Yavari F, Salehinejad MA, Nitsche MA. A Systematic Review on the Effect of Transcranial Direct Current and Magnetic Stimulation on Fear Memory and Extinction. Front Hum Neurosci 2021; 15:655947. [PMID: 33828472 PMCID: PMC8019721 DOI: 10.3389/fnhum.2021.655947] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022] Open
Abstract
Anxiety disorders are among the most prevalent mental disorders. Present treatments such as cognitive behavior therapy and pharmacological treatments show only moderate success, which emphasizes the importance for the development of new treatment protocols. Non-invasive brain stimulation methods such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have been probed as therapeutic option for anxiety disorders in recent years. Mechanistic information about their mode of action, and most efficient protocols is however limited. Here the fear extinction model can serve as a model of exposure therapies for studying therapeutic mechanisms, and development of appropriate intervention protocols. We systematically reviewed 30 research articles that investigated the impact of rTMS and tDCS on fear memory and extinction in animal models and humans, in clinical and healthy populations. The results of these studies suggest that tDCS and rTMS can be efficient methods to modulate fear memory and extinction. Furthermore, excitability-enhancing stimulation applied over the vmPFC showed the strongest potential to enhance fear extinction. We further discuss factors that determine the efficacy of rTMS and tDCS in the context of the fear extinction model and provide future directions to optimize parameters and protocols of stimulation for research and treatment.
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Affiliation(s)
- Vuk Marković
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- International Graduate School of Neuroscience, Ruhr-University-Bochum, Bochum, Germany
| | | | - Fatemeh Yavari
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Mohammad A. Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Michael A. Nitsche
- International Graduate School of Neuroscience, Ruhr-University-Bochum, Bochum, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
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Sánchez-León CA, Cordones I, Ammann C, Ausín JM, Gómez-Climent MA, Carretero-Guillén A, Sánchez-Garrido Campos G, Gruart A, Delgado-García JM, Cheron G, Medina JF, Márquez-Ruiz J. Immediate and after effects of transcranial direct-current stimulation in the mouse primary somatosensory cortex. Sci Rep 2021; 11:3123. [PMID: 33542338 PMCID: PMC7862679 DOI: 10.1038/s41598-021-82364-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/24/2020] [Indexed: 01/30/2023] Open
Abstract
Transcranial direct-current stimulation (tDCS) is a non-invasive brain stimulation technique consisting in the application of weak electric currents on the scalp. Although previous studies have demonstrated the clinical value of tDCS for modulating sensory, motor, and cognitive functions, there are still huge gaps in the knowledge of the underlying physiological mechanisms. To define the immediate impact as well as the after effects of tDCS on sensory processing, we first performed electrophysiological recordings in primary somatosensory cortex (S1) of alert mice during and after administration of S1-tDCS, and followed up with immunohistochemical analysis of the stimulated brain regions. During the application of cathodal and anodal transcranial currents we observed polarity-specific bidirectional changes in the N1 component of the sensory-evoked potentials (SEPs) and associated gamma oscillations. On the other hand, 20 min of cathodal stimulation produced significant after-effects including a decreased SEP amplitude for up to 30 min, a power reduction in the 20-80 Hz range and a decrease in gamma event related synchronization (ERS). In contrast, no significant changes in SEP amplitude or power analysis were observed after anodal stimulation except for a significant increase in gamma ERS after tDCS cessation. The polarity-specific differences of these after effects were corroborated by immunohistochemical analysis, which revealed an unbalance of GAD 65-67 immunoreactivity between the stimulated versus non-stimulated S1 region only after cathodal tDCS. These results highlight the differences between immediate and after effects of tDCS, as well as the asymmetric after effects induced by anodal and cathodal stimulation.
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Affiliation(s)
- Carlos A. Sánchez-León
- grid.15449.3d0000 0001 2200 2355Department of Physiology, Anatomy and Cell Biology, Pablo de Olavide University, Ctra. de Utrera, km. 1, 41013 Seville, Spain
| | - Isabel Cordones
- grid.15449.3d0000 0001 2200 2355Department of Physiology, Anatomy and Cell Biology, Pablo de Olavide University, Ctra. de Utrera, km. 1, 41013 Seville, Spain
| | - Claudia Ammann
- grid.428486.40000 0004 5894 9315HM CINAC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - José M. Ausín
- grid.157927.f0000 0004 1770 5832Instituto de Investigación E Innovación en Bioingeniería, Universidad Politécnica de Valencia, Valencia, Spain
| | - María A. Gómez-Climent
- grid.15449.3d0000 0001 2200 2355Department of Physiology, Anatomy and Cell Biology, Pablo de Olavide University, Ctra. de Utrera, km. 1, 41013 Seville, Spain
| | - Alejandro Carretero-Guillén
- grid.15449.3d0000 0001 2200 2355Department of Physiology, Anatomy and Cell Biology, Pablo de Olavide University, Ctra. de Utrera, km. 1, 41013 Seville, Spain
| | - Guillermo Sánchez-Garrido Campos
- grid.15449.3d0000 0001 2200 2355Department of Physiology, Anatomy and Cell Biology, Pablo de Olavide University, Ctra. de Utrera, km. 1, 41013 Seville, Spain
| | - Agnès Gruart
- grid.15449.3d0000 0001 2200 2355Department of Physiology, Anatomy and Cell Biology, Pablo de Olavide University, Ctra. de Utrera, km. 1, 41013 Seville, Spain
| | - José M. Delgado-García
- grid.15449.3d0000 0001 2200 2355Department of Physiology, Anatomy and Cell Biology, Pablo de Olavide University, Ctra. de Utrera, km. 1, 41013 Seville, Spain
| | - Guy Cheron
- grid.8364.90000 0001 2184 581XLaboratory of Electrophysiology, Université de Mons, Mons, Belgium ,grid.4989.c0000 0001 2348 0746Laboratory of Neurophysiology and Movement Biomechanics, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Javier F. Medina
- grid.39382.330000 0001 2160 926XDepartment of Neuroscience, Baylor College of Medicine, Houston, TX USA
| | - Javier Márquez-Ruiz
- grid.15449.3d0000 0001 2200 2355Department of Physiology, Anatomy and Cell Biology, Pablo de Olavide University, Ctra. de Utrera, km. 1, 41013 Seville, Spain
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Scaffolding the attention-deficit/hyperactivity disorder brain using transcranial direct current and random noise stimulation: A randomized controlled trial. Clin Neurophysiol 2021; 132:699-707. [PMID: 33561725 DOI: 10.1016/j.clinph.2021.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Improving symptomology and cognitive deficits in neurodevelopmental disorders is a crucial challenge. We examined whether neurostimulation protocols, which have been shown to yield long-term effects when combined with cognitive training, could benefit children with Attention-deficit/hyperactivity-disorder (ADHD), the most common neurodevelopmental disorder in childhood. METHODS We used a randomized double-blind active-controlled crossover study of 19 unmedicated children with ADHD, who received either anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (dlPFC) or random noise stimulation (tRNS) over the bilateral dlPFC, while completing executive functions training. RESULTS For our primary outcome, tRNS yielded a clinical improvement as indicated by the reduced ADHD rating-scale score from baseline, and in comparison to the changes observed in tDCS. The effect of brain stimulation one week after completion of treatment yielded further improvement, suggesting a neuroplasticity-related effect. Finally, tRNS improved working memory compared to tDCS, and a larger tRNS effect on ADHD rating-scale was predicted for those who showed the greatest improvement in working memory. CONCLUSIONS We found that our intervention can have a lasting effect, rather than a merely immediate effect as was shown for in previous medical interventions in ADHD. SIGNIFICANCE Our results provide a promising direction toward a novel intervention in ADHD.
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The role of dorsolateral and ventromedial prefrontal cortex in the processing of emotional dimensions. Sci Rep 2021; 11:1971. [PMID: 33479323 PMCID: PMC7819980 DOI: 10.1038/s41598-021-81454-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/06/2021] [Indexed: 01/29/2023] Open
Abstract
The ventromedial and dorsolateral prefrontal cortex are two major prefrontal regions that usually interact in serving different cognitive functions. On the other hand, these regions are also involved in cognitive processing of emotions but their contribution to emotional processing is not well-studied. In the present study, we investigated the role of these regions in three dimensions (valence, arousal and dominance) of emotional processing of stimuli via ratings of visual stimuli performed by the study participants on these dimensions. Twenty- two healthy adult participants (mean age 25.21 ± 3.84 years) were recruited and received anodal and sham transcranial direct current stimulation (tDCS) (1.5 mA, 15 min) over the dorsolateral prefrontal cortex (dlPFC) and and ventromedial prefrontal cortex (vmPFC) in three separate sessions with an at least 72-h interval. During stimulation, participants underwent an emotional task in each stimulation condition. The task included 100 visual stimuli and participants were asked to rate them with respect to valence, arousal, and dominance. Results show a significant effect of stimulation condition on different aspects of emotional processing. Specifically, anodal tDCS over the dlPFC significantly reduced valence attribution for positive pictures. In contrast, anodal tDCS over the vmPFC significantly reduced arousal ratings. Dominance ratings were not affected by the intervention. Our results suggest that the dlPFC is involved in control and regulation of valence of emotional experiences, while the vmPFC might be involved in the extinction of arousal caused by emotional stimuli. Our findings implicate dimension-specific processing of emotions by different prefrontal areas which has implications for disorders characterized by emotional disturbances such as anxiety or mood disorders.
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Breitling-Ziegler C, Zaehle T, Wellnhofer C, Dannhauer M, Tegelbeckers J, Baumann V, Flechtner HH, Krauel K. Effects of a five-day HD-tDCS application to the right IFG depend on current intensity: A study in children and adolescents with ADHD. PROGRESS IN BRAIN RESEARCH 2021; 264:117-150. [PMID: 34167653 DOI: 10.1016/bs.pbr.2021.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Impaired executive functions in ADHD are associated with hypoactivity of the right inferior frontal gyrus (IFG). This region was targeted via repetitive applications of anodal, high-definition transcranial direct current simulation (HD-tDCS) on five consecutive days in 33 ADHD patients (10-17years) and in a healthy control group (n=13, only sham). Patients received either sham (n=13) or verum tDCS with 0.5mA (n=9) or 0.25mA (n=11) depending on individual cutaneous sensitivity. During stimulation, participants performed a combined working memory and response inhibition paradigm (n-back/nogo). At baseline, post, and a 4-month follow up, electroencephalography was recorded during this task. Moreover, interference control (flanker task) and spatial working memory (spanboard task) were assessed to explore possible transfer effects. Omission errors and reaction time variability in all tasks served as measures of attention. In the 0.25mA group increased nogo commission errors indicated a detrimental tDCS effect on response inhibition. After the 5-day stimulation, attentional improvements in the 0.5mA group were indicated by reduced omission errors and reaction time variability. Variability improvements were still evident at follow up. In all groups, nogo P3 amplitudes were reduced post-stimulation, but in the 0.5mA group this reduction was smaller than in the 0.25mA group. Results of the current study suggest distinct effects of tDCS with different current intensities demonstrating the importance of a deeper understanding on the impact of stimulation parameters and repeated tDCS applications to develop effective tDCS-based therapy approaches in ADHD.
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Affiliation(s)
- Carolin Breitling-Ziegler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany.
| | - Tino Zaehle
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Otto von Guericke University, Magdeburg, Germany
| | - Christian Wellnhofer
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Moritz Dannhauer
- Scientific Computing and Imaging Institute, Center for Integrated Biomedical Computing, University of Utah, Salt Lake City, UT, United States
| | - Jana Tegelbeckers
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany; Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Valentin Baumann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Hans-Henning Flechtner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Kerstin Krauel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Otto von Guericke University, Magdeburg, Germany
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Salehinejad MA, Ghanavati E, Rashid MHA, Nitsche MA. Hot and cold executive functions in the brain: A prefrontal-cingular network. Brain Neurosci Adv 2021; 5:23982128211007769. [PMID: 33997292 PMCID: PMC8076773 DOI: 10.1177/23982128211007769] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022] Open
Abstract
Executive functions, or cognitive control, are higher-order cognitive functions needed for adaptive goal-directed behaviours and are significantly impaired in majority of neuropsychiatric disorders. Different models and approaches are proposed for describing how executive functions are functionally organised in the brain. One popular and recently proposed organising principle of executive functions is the distinction between hot (i.e. reward or affective-related) versus cold (i.e. purely cognitive) domains of executive functions. The prefrontal cortex is traditionally linked to executive functions, but on the other hand, anterior and posterior cingulate cortices are hugely involved in executive functions as well. In this review, we first define executive functions, their domains, and the appropriate methods for studying them. Second, we discuss how hot and cold executive functions are linked to different areas of the prefrontal cortex. Next, we discuss the association of hot versus cold executive functions with the cingulate cortex, focusing on the anterior and posterior compartments. Finally, we propose a functional model for hot and cold executive function organisation in the brain with a specific focus on the fronto-cingular network. We also discuss clinical implications of hot versus cold cognition in major neuropsychiatric disorders (depression, schizophrenia, anxiety disorders, substance use disorder, attention-deficit hyperactivity disorder, and autism) and attempt to characterise their profile according to the functional dominance or manifest of hot-cold cognition. Our model proposes that the lateral prefrontal cortex along with the dorsal anterior cingulate cortex are more relevant for cold executive functions, while the medial-orbital prefrontal cortex along with the ventral anterior cingulate cortex, and the posterior cingulate cortex are more closely involved in hot executive functions. This functional distinction, however, is not absolute and depends on several factors including task features, context, and the extent to which the measured function relies on cognition and emotion or both.
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Affiliation(s)
- Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Elham Ghanavati
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Md Harun Ar Rashid
- 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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Ney LJ, Vicario CM, Nitsche MA, Felmingham KL. Timing matters: Transcranial direct current stimulation after extinction learning impairs subsequent fear extinction retention. Neurobiol Learn Mem 2020; 177:107356. [PMID: 33278591 DOI: 10.1016/j.nlm.2020.107356] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/01/2020] [Accepted: 11/29/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) has previously been shown to improve fear extinction learning and retention when administered prior to or during extinction learning. This study investigates whether tDCS immediately following extinction learning improves efficacy of extinction memory retention. METHODS 30 participants completed a 2-day fear learning and extinction paradigm, where they acquired fear of a stimulus conditioned to an aversive electric shock on day 1. Extinction learning occurred on day 1, with tDCS or sham tDCS administered immediately following the learning phase. Participants returned for a second day test of extinction memory recall. Skin conductance was measured as the primary outcome. RESULTS/CONCLUSIONS Participants in the tDCS group showed impaired fear extinction retention on day 2, marked by significant generalisation of fear to the safety stimulus. This contrasts with earlier studies showing improved extinction retention when stimulation occurred during encoding of extinction learning, compared to immediate consolidation as in our study. These findings may have important implications for the use of tDCS during exposure therapy for anxiety and trauma disorders.
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Affiliation(s)
- Luke J Ney
- School of Psychology, University of Tasmania, Australia.
| | - Carmelo M Vicario
- University of Messina, Department of Scienze Cognitive Della Formazione e Degli Studi Culturali, Messina, Italy.
| | - Michael A Nitsche
- Deptartment of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Australia
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50
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Cosmo C, DiBiasi M, Lima V, Grecco LC, Muszkat M, Philip NS, de Sena EP. A systematic review of transcranial direct current stimulation effects in attention-deficit/hyperactivity disorder. J Affect Disord 2020; 276:1-13. [PMID: 32697687 PMCID: PMC8128973 DOI: 10.1016/j.jad.2020.06.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/15/2020] [Accepted: 06/23/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) stands out as the most prevalent neurodevelopmental disorder of childhood, with global prevalence ranging from 3.4% to 7•2%. Its cognitive symptoms result from the combination of complex etiological processes encompassing genetic and environmental components. Available therapeutic approaches are associated with significant challenges such as modest efficacy or side effects. Transcranial direct current stimulation (tDCS) is a promising tool for enhancing cognitive performance in neuropsychiatric disorders. Trials investigating its applicability in ADHD have showed propitious, however, still preliminary findings. METHODS We performed a systemic review by searching on Medline, Cochrane Library, Web of Science, ScienceDirect and Embase using the descriptors: "attention-deficit/hyperactivity disorder" or "ADHD"; and "transcranial direct current stimulation" or "tDCS"; following PRISMA guidelines. RESULTS A total of 383 articles were identified. After removing duplicates, 45 studies were assessed for eligibility, and after careful review, 11 manuscripts applying tDCS in ADHD were included. Significant improvements in attention, inhibitory control and working memory were reported, in addition to increased brain connectivity following use of active tDCS. LIMITATIONS The main limitation was the small number of trials investigating use of tDCS in ADHD. Study methods and outcome measures were quite variable, and generally did not include long-term follow-up. CONCLUSIONS Although the extent literature indicates promising findings, the available data remains highly preliminary. Further trials evaluating the efficacy of tDCS for ADHD, with longer follow-up, are necessary. These studies will be needed to determine the optimal protocol for clinical efficacy.
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Affiliation(s)
- Camila Cosmo
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Butler Campus, Box G-BH, 345 Blackstone Boulevard, Providence, RI 02906, USA; Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA.
| | - Melany DiBiasi
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Vania Lima
- Department of Hearing and Speech Pathology, Federal University of São Paulo, Brazil
| | | | - Mauro Muszkat
- Psychobiology Department, Federal University of São Paulo, Brazil
| | - Noah S Philip
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Butler Campus, Box G-BH, 345 Blackstone Boulevard, Providence, RI 02906, USA; Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
| | - Eduardo Pondé de Sena
- Postgraduate Program in Interactive Process of Organs and Systems, Federal University of Bahia, Brazil
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