Department of Child & Adolescent Psychiatry, King's College London, London, UK.
School of Psychology, University of Surrey, Guildford, UK.
Psychol Med. 2023 Jan;53(2):497-512. doi: 10.1017/S0033291721001859. Epub 2021 Jul 6.
Transcranial direct current stimulation (tDCS) could be a side-effect-free alternative to psychostimulants in attention-deficit/hyperactivity disorder (ADHD). Although there is limited evidence for clinical and cognitive effects, most studies were small, single-session and stimulated left dorsolateral prefrontal cortex (dlPFC). No sham-controlled study has stimulated the right inferior frontal cortex (rIFC), which is the most consistently under-functioning region in ADHD, with multiple anodal-tDCS sessions combined with cognitive training (CT) to enhance effects. Thus, we investigated the clinical and cognitive effects of multi-session anodal-tDCS over rIFC combined with CT in double-blind, randomised, sham-controlled trial (RCT, ISRCTN48265228).
Fifty boys with ADHD (10-18 years) received 15 weekday sessions of anodal- or sham-tDCS over rIFC combined with CT (20 min, 1 mA). ANCOVA, adjusting for baseline measures, age and medication status, tested group differences in clinical and ADHD-relevant executive functions at posttreatment and after 6 months.
ADHD-Rating Scale, Conners ADHD Index and adverse effects were significantly lower at post-treatment after sham relative to anodal tDCS. No other effects were significant.
This rigorous and largest RCT of tDCS in adolescent boys with ADHD found no evidence of improved ADHD symptoms or cognitive performance following multi-session anodal tDCS over rIFC combined with CT. These findings extend limited meta-analytic evidence of cognitive and clinical effects in ADHD after 1-5 tDCS sessions over mainly left dlPFC. Given that tDCS is commercially and clinically available, the findings are important as they suggest that rIFC stimulation may not be indicated as a neurotherapy for cognitive or clinical remediation for ADHD.
经颅直流电刺激（tDCS）可能是治疗注意缺陷多动障碍（ADHD）的一种无副作用的替代药物。虽然有有限的临床和认知效果证据，但大多数研究规模较小，单次治疗，刺激左背外侧前额叶皮层（dlPFC）。没有假刺激对照研究刺激右侧下额叶皮层（rIFC），rIFC 是 ADHD 中最一致的功能低下区域，采用多次阳极 tDCS 与认知训练（CT）相结合来增强效果。因此，我们在双盲、随机、假刺激对照试验（RCT，ISRCTN48265228）中研究了 rIFC 多次阳极 tDCS 与 CT 联合治疗对 ADHD 的临床和认知效果。
50 名患有 ADHD（10-18 岁）的男孩接受了 rIFC 联合 CT 的 15 个工作日的阳极或假刺激治疗（20 分钟，1 mA）。调整基线测量、年龄和药物状态的协方差分析（ANCOVA）测试了治疗后和 6 个月后治疗组在临床和 ADHD 相关执行功能方面的差异。
与阳极刺激相比，治疗后假刺激组的 ADHD 评定量表、康纳多动指数和不良反应明显降低。其他结果无显著差异。
这项对青少年 ADHD 男孩进行的最严格和最大规模的 tDCS RCT 发现，rIFC 联合 CT 多次阳极 tDCS 治疗后，ADHD 症状或认知表现无改善证据。这些发现扩展了有限的元分析证据，即在主要左 dlPFC 上进行 1-5 次 tDCS 治疗后，ADHD 的认知和临床效果。鉴于 tDCS 在商业和临床中可用，这些发现很重要，因为它们表明 rIFC 刺激可能不适用于 ADHD 的神经治疗或认知矫正。
