儿童和成人注意缺陷多动障碍的非侵入性脑刺激：系统评价和荟萃分析。
Noninvasive brain stimulation in children and adults with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis.
机构信息
From the Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom (Westwood, Rubia); the Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain (Radua); the Mental Health Research Networking Centre (CIBERSAM), Madrid, Spain (Radua); the Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, Sweden (Radua); and the Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, United Kingdom (Radua).
出版信息
J Psychiatry Neurosci. 2021 Jan 4;46(1):E14-E33. doi: 10.1503/jpn.190179.
BACKGROUND
Repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) could provide treatment alternatives to stimulant medication for attention-deficit/hyperactivity disorder (ADHD), given some evidence for improvements in cognition and clinical symptoms. However, despite a lack of solid evidence for their use, rTMS and tDCS are already offered clinically and commercially in ADHD. This systematic review and meta-analysis aimed to critically appraise rTMS and tDCS studies in ADHD to inform good research and clinical practice.
METHODS
A systematic search (up to February 2019) identified 18 studies (rTMS 4, tDCS 14; 311 children and adults with ADHD) stimulating mainly the dorsolateral prefrontal cortex (dlPFC). We included 12 anodal tDCS studies (232 children and adults with ADHD) in 3 random-effects meta-analyses of cognitive measures of attention, inhibition and processing speed.
RESULTS
The review of rTMS and tDCS showed positive effects in some functions but not others, and little evidence for clinical improvement. The meta-analyses of 1 to 5 sessions of anodal tDCS over mainly the left or bilateral dlPFC showed trend-level improvements in inhibition and processing speed, but not in attention.
LIMITATIONS
Heterogeneity in stimulation parameters, patient age and outcome measures limited the interpretation of findings.
CONCLUSION
The review and meta-analysis showed limited evidence that 1 to 5 sessions of rTMS and tDCS, mostly of the dlPFC, improved clinical or cognitive measures of ADHD. These findings did not support using rTMS or tDCS of the dlPFC as an alternative neurotherapy for ADHD as yet. Larger, multi-session stimulation studies identifying more optimal sites and stimulation parameters in combination with cognitive training could achieve larger effects.
背景
重复经颅磁刺激（rTMS）或经颅直流电刺激（tDCS）可以为注意力缺陷多动障碍（ADHD）提供除兴奋剂药物之外的治疗选择，因为有一些证据表明它们可以改善认知和临床症状。然而，尽管缺乏其使用的确凿证据，rTMS 和 tDCS 已经在 ADHD 中得到临床和商业应用。本系统评价和荟萃分析旨在批判性评估 rTMS 和 tDCS 在 ADHD 中的研究，为良好的研究和临床实践提供信息。
方法
系统检索（截至 2019 年 2 月）确定了 18 项研究（rTMS4 项，tDCS14 项；311 名患有 ADHD 的儿童和成人），主要刺激背外侧前额叶皮质（dlPFC）。我们纳入了 12 项单极 tDCS 研究（232 名患有 ADHD 的儿童和成人），对注意力、抑制和处理速度的认知测量进行了 3 项随机效应荟萃分析。
结果
rTMS 和 tDCS 的综述显示，在某些功能上有积极的效果，但在其他功能上没有，而且几乎没有临床改善的证据。对左或双侧 dlPFC 主要进行 1 到 5 次单极 tDCS 的荟萃分析显示，抑制和处理速度有趋势性改善，但注意力没有改善。
局限性
刺激参数、患者年龄和结果测量的异质性限制了研究结果的解释。
结论
本综述和荟萃分析表明，1 到 5 次 rTMS 和 tDCS，主要是 dlPFC，对 ADHD 的临床或认知测量有有限的改善作用。这些发现还不支持将 dlPFC 的 rTMS 或 tDCS 作为 ADHD 的神经治疗替代方法。更大规模、多次刺激的研究，结合认知训练确定更优化的部位和刺激参数，可能会产生更大的效果。
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