D'Aiello Barbara, Lazzaro Giulia, Battisti Andrea, Pani Pierpaolo, Di Vara Silvia, De Rossi Pietro, Pretelli Italo, Costanzo Floriana, Vicari Stefano, Menghini Deny
Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Department of Human Science, LUMSA University, Rome, Italy.
Front Neurosci. 2023 Jul 7;17:1170090. doi: 10.3389/fnins.2023.1170090. eCollection 2023.
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.
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.
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.
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.
注意力缺陷多动障碍（ADHD）的特征是存在不适当、普遍且持续的注意力不集中、多动和/或冲动模式，并伴有严重的功能损害。尽管在ADHD的理解和管理方面取得了相当大的进展，但一些患者对首选药物治疗哌甲酯（MPH）反应不佳。在过去几十年中，在非侵入性脑刺激技术中，经颅直流电刺激（tDCS）已被证明是一种有效且安全的技术，可通过改变皮层兴奋性来改善患有神经发育障碍（包括ADHD）儿童的行为和认知。然而，tDCS的效果从未与MPH的效果进行过直接比较。本随机假对照试验评估了在患有ADHD的儿童和青少年中，单次阳极tDCS与单次服用MPH的效果。
在完成基线评估（T0）后，26名患有ADHD的儿童和青少年在24小时间隔的时段内接受3种情况：（A）在左侧背外侧前额叶皮层（DLPFC）进行单次阳极tDCS；（B）在左侧DLPFC进行单次假tDCS；（C）单次服用MPH。
我们的结果表明，与基线、阳极和假tDCS相比，患有ADHD的儿童和青少年在单次服用MPH后，抑制控制和视觉空间工作记忆得到改善。然而，与基线或假tDCS相比，在左侧DLPFC进行单次主动tDCS无效。
总之，我们在ADHD中涉及单次tDCS治疗的方案与基线、假tDCS或单次服用MPH相比，并未显示出神经认知特征的持续改善。需要制定不同的方案来进一步测试tDCS改善ADHD症状的有效性。
