This article is freely available to all

Prim Care Companion CNS Disord 2021;23(3):20br02602

To cite: Patel RK, Saeed H, Mekala HM, et al. Transcranial magnetic stimulation for adolescents with ADHD. Prim Care Companion CNS Disord. 2021;23(3):20br02602.
To share: https://doi.org/10.4088/PCC.20br02602

© Copyright 2021 Physicians Postgraduate Press, Inc.

aDepartment of Public Health, Arcadia University, Glenside, Pennsylvania
bHorizon Treatment Centers of Louisiana, Baton Rouge, Louisiana
cGriffin Memorial Hospital, Norman, Oklahoma
dDepartment of Pyschiatry, University of Louisville School of Medicine, Louisville, Kentucky
*Corresponding author: Steven Lippmann, MD, 401 East Chestnut St, Ste 610, University of Louisville School of Medicine, Louisville, KY 40202 ([email protected]).

 

 

Attention-deficit/hyperactivity disorder (ADHD) is the most common neuropsychiatric condition of children and adolescents, and it often persists into adulthood.1,2 Medications and cognitive-behavioral therapy are the main interventions to address ADHD symptoms. Psychostimulants have proven efficacy as a standard pharmacotherapy for ADHD; however, these drugs are sometimes not prescribed because they can induce reductions in appetite, weight, or height among children; alterations in cardiovascular function; and sudden death associated with structural heart disease.3,4 The delayed impact of psychotherapies and unacceptability of medication in some patients has prompted consideration of other ways to manage their ADHD concerns.

Transcranial magnetic stimulation (TMS) is a noninvasive, well-tolerated, and promising therapy for various neuropsychiatric disorders.5 TMS was approved for treating patients with depression in 2008.4,5 Later research focused on pediatric subjects for conditions including bipolar disorder, depression, schizophrenia, myoclonus, and progressive myoclonus epilepsy.4 TMS has been employed as a diagnostic tool for patients with ADHD, bipolar disorder, depression, schizophrenia, obsessive-compulsive disorder, and Tourette’s syndrome.5

TMS therapeutically induces a blood flow change, gene modulation or expression, and release of peptides and trophic factors.4 Dysregulation of dopamine is part of the biochemistry involved with ADHD, depression, schizophrenia, and Parkinson’s disease, and TMS enhances dopamine release from the prefrontal cortex.6 TMS can diminish symptoms of ADHD in adolescents.3

TMS improves understanding of the pathophysiology of ADHD and augments research to discover other interventions for patients.7,8 Dysfunctions of dopamine modulation are documented in the pathology of ADHD; diminished ADHD symptoms induced by dopamine-regulating medications add to the evidence of this correlation at lessening ADHD manifestations.4 During an ADHD intervention, TMS relies on evoked potentials (eg, N100), causing cortical inhibition. There may also be an association between ADHD and gene anomalies of dopamine receptors that explains cortical neuron inhibition.4 These neurons are noninvasively depolarized by TMS-evoked potentials to become intracortical facilitatory or inhibitory pathways.3–8 TMS can differentiate developmental delays from persistent inhibitory deficits of ADHD by documenting differences in latency and amplitude of evoked potentials. These features open inquiry about cortical development as an inhibitory deficit associated with ADHD.4 TMS-evoked potential observations facilitate an assessment of cortical inhibition mediated by corticostriatal fibers without spinal inhibitory influence.9

TMS has promise as an intervention for treating adolescents and also adults with manifestations of ADHD.1,3 Besides efficacy, advantages of TMS are that it is noninvasive and well tolerated. Disadvantages include high cost and risk of adverse events. Seizures, short-term memory impairment, and headaches are documented in some study subjects.3,4

Published online: May 27, 2021.
Potential conflicts of interest: None.
Funding/support: None.

  1. Department of Public Health, Arcadia University, Glenside, Pennsylvania
  2. Horizon Treatment Centers of Louisiana, Baton Rouge, Louisiana
  3. Griffin Memorial Hospital, Norman, Oklahoma
  4. Department of Pyschiatry, University of Louisville School of Medicine, Louisville, Kentucky
  5. Corresponding author: Steven Lippmann, MD, 401 East Chestnut St, Ste 610, University of Louisville School of Medicine, Louisville, KY 40202 ([email protected]).
  1. Fayyad J, De Graaf R, Kessler R, et al. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry. 2007;190(5):402–409. PubMed CrossRef
  2. Wolraich M, Brown L, Brown RT, et al; Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128(5):1007–1022. PubMed CrossRef
  3. Weaver L, Rostain AL, Mace W, et al. Transcranial magnetic stimulation (TMS) in the treatment of attention-deficit/hyperactivity disorder in adolescents and young adults: a pilot study. J ECT. 2012;28(2):98–103. PubMed CrossRef
  4. Acosta MT, Leon-Sarmiento FE. Repetitive transcranial magnetic stimulation (rTMS): new tool, new therapy and new hope for ADHD. Curr Med Res Opin. 2003;19(2):125–130. PubMed CrossRef
  5. Zaman R. Transcranial magnetic stimulation (TMS) in attention deficit hyperactivity disorder (ADHD). Psychiatr Danub. 2015;27(suppl 1):S530–S532. PubMed
  6. Wassermann EM. Side effects of repetitive transcranial magnetic stimulation. Depress Anxiety. 2000;12(3):124–129. PubMed CrossRef
  7. Bruckmann S, Hauk D, Roessner V, et al. Cortical inhibition in attention deficit hyperactivity disorder: new insights from the electroencephalographic response to transcranial magnetic stimulation. Brain. 2012;135(pt 7):2215–2230. PubMed CrossRef
  8. D’Agati E, Hoegl T, Dippel G, et al. Motor cortical inhibition in ADHD: modulation of the transcranial magnetic stimulation-evoked N100 in a response control task. J Neural Transm (Vienna). 2014;121(3):315–325. PubMed CrossRef
  9. Bloch Y, Harel EV, Aviram S, et al. Positive effects of repetitive transcranial magnetic stimulation on attention in ADHD subjects: a randomized controlled pilot study. World J Biol Psychiatry. 2010;11(5):755–758. PubMed CrossRef