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Lodewyk K, Bagnell A, MacMaster FP, Newton AS. Adverse event monitoring and reporting in pediatric neuromodulatory studies: A systematic review. J Psychiatr Res 2024; 175:359-367. [PMID: 38761518 DOI: 10.1016/j.jpsychires.2024.05.035] [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: 10/19/2023] [Revised: 04/16/2024] [Accepted: 05/14/2024] [Indexed: 05/20/2024]
Abstract
Neuromodulatory interventions are relatively novel and approaches to studying harms and tolerability have varied. Using a checklist based on guidelines from Good Clinical Practice and the Harms Extension of the CONSORT (Consolidated Standards of Reporting Trials) Statement, we identified how adverse events are measured, assessed, and reported in studies evaluating neuromodulation for the treatment of mental and neurodevelopmental disorders among children and adolescents. A systematic literature review identified 56 experimental and quasi-experimental studies evaluating transcranial magnetic stimulation (TMS), transcranial alternating (tACS) or direct (tDCS) current stimulation, transcranial pulse stimulation (TPS), and vagus or trigeminal nerve stimulation (VNS or TNS). For 22 studies (39%), the types of adverse events to be monitored were identified, and for 31 studies (55%), methods for collecting adverse event data were described. Methods for assessing adverse events were less commonly described with 23 studies (41%) having details on assessing event severity, and 11 studies (20%) having details on assessing event causality. Among 31 studies with reported results, headache, skin irritation, and general pain or discomfort were the most reported across studies. Seizure, untoward medical occurrences, and intracranial bleeding, edema, or other intracranial pathology were considered serious events, but these events were not reported as occurring in any results-based papers. Taken together, the findings from this review indicate that most studies of pediatric neuromodulatory interventions did not include descriptions of adverse event monitoring and evaluation. Comprehensive event monitoring and reporting across studies can significantly augment the current knowledge base.
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Affiliation(s)
- Kalee Lodewyk
- University of Alberta, 3-526 Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Alexa Bagnell
- IWK Health, 5980 University Ave #5850, Halifax, Nova Scotia, B3K 6R8, Canada.
| | - Frank P MacMaster
- IWK Health, 5980 University Ave #5850, Halifax, Nova Scotia, B3K 6R8, Canada.
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, 3-526 Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
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Estaji R, Hosseinzadeh M, Arabgol F, Nejati V. Transcranial direct current stimulation (tDCS) improves emotion regulation in children with attention-deficit hyperactivity disorder (ADHD). Sci Rep 2024; 14:13889. [PMID: 38880826 PMCID: PMC11180663 DOI: 10.1038/s41598-024-64886-9] [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: 01/27/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024] Open
Abstract
Children with attention deficit/hyperactivity disorder (ADHD) typically exhibit difficulties in emotion regulation. It has been shown that the dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC) are crucially involved in these deficient processes. In this study, we aimed to explore the impact of electrical stimulation over the left dlPFC and right vmPFC on emotion regulation in children with ADHD. Twenty-four children with ADHD completed the Emotional Go/No-Go and Emotional 1-Back tasks while undergoing transcranial direct current stimulation (tDCS) in three separate sessions, each with a different electrode placement: anodal dlPFC (F3)/cathodal vmPFC (Fp2), anodal vmPFC (Fp2)/cathodal dlPFC (F3), and sham stimulation. During both real tDCS conditions, the accuracy of pre-potent inhibitory control and working memory performance improved, but not speed. This study provides evidence that the left dlPFC and the right vmPFC are involved in emotion regulation in ADHD.
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Affiliation(s)
- Reza Estaji
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Mariam Hosseinzadeh
- Department of Psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Arabgol
- Department of Psychiatry, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran.
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Nejati V, Dehghan M, Shahidi S, Estaji R, Nitsche MA. Transcranial random noise stimulation (tRNS) improves hot and cold executive functions in children with attention deficit-hyperactivity disorder (ADHD). Sci Rep 2024; 14:7600. [PMID: 38556535 PMCID: PMC10982302 DOI: 10.1038/s41598-024-57920-3] [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: 08/14/2023] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
Children with attention deficit-hyperactivity disorder (ADHD) have impaired hot and cold executive functions, which is thought to be related to impaired ventromedial and dorsolateral prefrontal cortex (vmPFC and dlPFC) functions. The present study aimed to assess the impact concurrent stimulation of dlPFC and vmPFC through transcranial random noise stimulation (tRNS), a non-invasive brain stimulation tool which enhances cortical excitability via application of alternating sinusoidal currents with random frequencies and amplitudes over the respective target regions on hot and cold executive functions. Eighteen children with ADHD received real and sham tRNS over the left dlPFC and the right vmPFC in two sessions with one week interval. The participants performed Circle Tracing, Go/No-Go, Wisconsin Card Sorting, and Balloon Analogue Risk Tasks during stimulation in each session. The results showed improved ongoing inhibition, prepotent inhibition, working memory, and decision making, but not set-shifting performance, during real, as compared to sham stimulation. This indicates that simultaneous stimulation of the dlPFC and the vmPFC improves hot and cold executive functions in children with ADHD.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University Tehran, P.O. Box: 1983969411, Tehran, Iran.
| | - Mahshid Dehghan
- Department of Psychology, Shahid Beheshti University Tehran, P.O. Box: 1983969411, Tehran, Iran
| | - Shahriar Shahidi
- Department of Psychology, Shahid Beheshti University Tehran, P.O. Box: 1983969411, Tehran, Iran
| | - Reza Estaji
- Department of Psychology, Shahid Beheshti University Tehran, P.O. Box: 1983969411, Tehran, Iran
| | - 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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Guimarães RSQ, Bandeira ID, Barretto BL, Wanke T, Alves COC, Barretto TL, de Carvalho CF, Dorea-Bandeira I, Tolentino A, Lins-Silva DH, Lucena PH, Lucena R. Efficacy and safety of transcranial direct current stimulation over the left dorsolateral prefrontal cortex in children and adolescents with attention-deficit/hyperactivity disorder: a randomized, triple-blinded, sham-controlled, crossover trial. Front Psychiatry 2024; 14:1217407. [PMID: 38268562 PMCID: PMC10806216 DOI: 10.3389/fpsyt.2023.1217407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Although pharmacological treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) has demonstrated efficacy, several individuals persist in experiencing social and academic impairment. Additionally, the occurrence of significant side effects may render the use of psychotropic medications untenable. However, Transcranial Direct Current Stimulation (tDCS), a non-invasive brain stimulation technique, shows promising results in treating ADHD. Objectives To investigate the efficacy and safety of tDCS on the performance of children and adolescents with ADHD in neuropsychological tests involving visual attention, visual and verbal working memory, and inhibitory control. Methodology This study was a triple-blind, randomized, sham-controlled, crossover clinical trial. The intervention consisted of a daily session of tDCS (2 mA) or sham targeting the left dorsolateral prefrontal cortex (L-DLPFC), for 30 min, on five consecutive days. The primary outcome was change in the Visual Attention Test, Fourth Edition (TAVIS-4) before and after each intervention. Subjects were also evaluated pre and post-tDCS using the Digit Span subtest of the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V), the Developmental Neuropsychological Assessment, Second Edition (NEPSY-II) Inhibiting Response (IR) subtest, and the Corsi Block-Tapping Task. Results Fifteen individuals were included, and no statistically significant difference was observed when comparing the results of the TAVIS-4, the IR of NEPSY-II, and the intragroup Digit Span subtest of WISC-V undertaken before and after the procedure. Adverse events were mainly self-limiting and transient. The participants did not perceive any benefit from tDCS when measured on the Patient Global Impression of Improvement (PGI-I) Scale. Conclusion This study did not meet its primary endpoint and found no performance enhancement in any investigated neuropsychological outcomes relating to the intervention group.
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Affiliation(s)
| | - Igor D. Bandeira
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | | | - Thamires Wanke
- Instituto de Psicologia, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | | | | | - Arthur Tolentino
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Pedro H. Lucena
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Rita Lucena
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
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Wang CSM, Chen PS, Tsai TY, Hou NT, Tang CH, Chen PL, Huang YC, Cheng KS. Cognitive Effect of Transcranial Direct Current Stimulation on Left Dorsolateral Prefrontal Cortex in Mild Alzheimer's Disease: A Randomized, Double-Blind, Cross-Over Small-Scale Exploratory Study. J Alzheimers Dis 2024; 98:563-577. [PMID: 38427493 DOI: 10.3233/jad-240002] [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] [Indexed: 03/03/2024]
Abstract
Background Transcranial direct current stimulation (tDCS) is considered a potential therapeutic instrument for Alzheimer's disease (AD) because it affects long-term synaptic plasticity through the processes of long-term potentiation and long-term depression, thereby improving cognitive ability. Nevertheless, the efficacy of tDCS in treating AD is still debated. Dorsal lateral prefrontal cortex is the main role in executive functions. Objective We investigate the cognitive effects of tDCS on AD patients. Methods Thirty mild AD patients aged 66-86 years (mean = 75.6) were included in a double-blind, randomized, sham-controlled crossover study. They were randomly assigned to receive 10 consecutive daily sessions of active tDCS (2 mA for 30 min) or a sham intervention and switched conditions 3 months later. The anodal and cathodal electrodes were placed on the left dorsal lateral prefrontal cortex and the right supraorbital area, respectively. Subjects underwent various neuropsychological assessments before and after the interventions. Results The results showed that tDCS significantly improved Cognitive Abilities Screening Instrument scores, especially on the items of "concentration and calculation", "orientation", "language ability", and "categorical verbal fluency". Mini-Mental State Examination and Wisconsin Card Sorting Test scores in all domains of "concept formation", "abstract thinking", "cognitive flexibility", and "accuracy" also improved significantly after tDCS. For the sham condition, no difference was found between the baseline scores and the after-intervention scores on any of the neuropsychological tests. Conclusion >: Using tDCS improves the cognition of AD patients. Further large size clinical trials are necessary to validate the data.
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Affiliation(s)
- Carol Sheei-Meei Wang
- Department of BioMedical Engineering, National Cheng Kung University, Tainan City, Taiwan
- Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan City, Taiwan
- Department of Psychiatry, College of Medicines, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, Taiwan
| | - Po See Chen
- Department of Psychiatry, College of Medicines, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, Taiwan
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Tsung-Yu Tsai
- Department of Psychiatry, College of Medicines, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, Taiwan
| | - Nien-Tsen Hou
- Department of Neurology, Tainan Hospital, Ministry of Health and Welfare, Tainan City, Taiwan
| | - Chia-Hung Tang
- Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan City, Taiwan
| | - Pai-Lien Chen
- Biostatistics Department, Family Health International (FHI) 360, Durham, NC, USA
| | - Ying-Che Huang
- Department of Neurology, Tainan Hospital, Ministry of Health and Welfare, Tainan City, Taiwan
| | - Kuo-Sheng Cheng
- Department of BioMedical Engineering, National Cheng Kung University, 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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