Transcranial direct current stimulation (tDCS) combined with cognitive training in adolescent boys with ADHD: a double-blind, randomised, sham-controlled trial

Abstract Background 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). Methods 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. Results 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. Conclusions 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.

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Transcranial direct current stimulation (tDCS) combined with cognitive training in adolescent boys with ADHD: a double-blind, randomised, sham-controlled trial

10.1101/2020.12.07.20245456 ◽

2020 ◽

Author(s):

Samuel J. Westwood ◽

Marion Criaud ◽

Sheut-Ling Lam ◽

Steve Lukito ◽

Sophie Wallace-Hanlon ◽

...

Keyword(s):

Adverse Effects ◽

Cognitive Training ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Controlled Trial ◽

Cognitive Effects ◽

Adhd Symptoms ◽

Anodal Tdcs ◽

Double Blind ◽

Direct Current Stimulation

ABSTRACTBackgroundTranscranial 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 right inferior frontal cortex (rIFC), which is the most consistently under-functioning region in ADHD, with multiple sessions of anodal tDCS combined with cognitive training (CT) to enhance effects.Objective/HypothesisTo investigate clinical and cognitive effects of multi-session anodal tDCS over rIFC combined with CT in a double-blind, randomised, sham-controlled trial (RCT).Methods50 boys with ADHD (10-18 years) received 15 weekday sessions of anodal or sham tDCS over rIFC combined with CT (20mins, 1mA). 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.ResultsADHD-Rating Scale, Conners ADHD Index, and adverse effects were significantly lower at post-treatment after sham relative to real tDCS. No other effects were significant.ConclusionsThis rigorous multi-session RCT of tDCS over the rIFC in ADHD combined with CT, showed no evidence of improvement of ADHD symptoms or cognitive performance. 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 ADHDHighlightstDCS has been suggested as an alternative treatment for ADHDWe combined 15-session anodal tDCS over the rIFC with cognitive training in ADHD childrenReal versus sham tDCS showed no cognitive or symptom improvementsConversely, real tDCS showed lower ADHD symptoms and higher adverse effectsMulti-session tDCS of rIFC shows no clinical or cognitive benefits in ADHD

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The effect of transcranial direct current stimulation (tDCS) combined with cognitive training on EEG spectral power in adolescent boys with ADHD: A double-blind, randomized, sham-controlled trial

IBRO Neuroscience Reports ◽

10.1016/j.ibneur.2021.12.005 ◽

2022 ◽

Vol 12 ◽

pp. 55-64

Author(s):

Samuel J. Westwood ◽

Natali Bozhilova ◽

Marion Criaud ◽

Sheut-Ling Lam ◽

Steve Lukito ◽

...

Keyword(s):

Cognitive Training ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Spectral Power ◽

Controlled Trial ◽

Adolescent Boys ◽

Double Blind ◽

Direct Current Stimulation ◽

Eeg Spectral Power

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Effects of transcranial direct current stimulation (tDCS) and concurrent cognitive training on episodic memory in patients with traumatic brain injury: a double-blind, randomised, placebo-controlled study

BMJ Open ◽

10.1136/bmjopen-2020-045285 ◽

2021 ◽

Vol 11 (8) ◽

pp. e045285

Author(s):

Daglie Jorge De Freitas ◽

Daniel De Carvalho ◽

Vanessa Maria Paglioni ◽

Andre R Brunoni ◽

Leandro Valiengo ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Episodic Memory ◽

Cognitive Training ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Sham Group ◽

Controlled Study ◽

Double Blind ◽

Direct Current Stimulation

IntroductionDeficits in episodic memory following traumatic brain injury (TBI) are common and affect independence in activities of daily living. Transcranial direct current stimulation (tDCS) and concurrent cognitive training may contribute to improve episodic memory in patients with TBI. Although previous studies have shown the potential of tDCS to improve cognition, the benefits of the tDCS applied simultaneously to cognitive training in participants with neurological disorders are inconsistent. This study aims to (1) investigate whether active tDCS combined with computer-assisted cognitive training enhances episodic memory compared with sham tDCS; (2) compare the differences between active tDCS applied over the left dorsolateral prefrontal cortex (lDLPFC) and bilateral temporal cortex (BTC) on episodic memory and; (3) investigate inter and intragroup changes on cortical activity measured by quantitative electroencephalogram (qEEG).Methods and analysisA randomised, parallel-group, double-blind placebo-controlled study is conducted. Thirty-six participants with chronic, moderate and severe closed TBI are being recruited and randomised into three groups (1:1:1) based on the placement of tDCS sponges and electrode activation (active or sham). TDCS is applied for 10 consecutive days for 20 min, combined with a computer-based cognitive training. Cognitive scores and qEEG are collected at baseline, on the last day of the stimulation session, and 3 months after the last tDCS session. We hypothesise that (1) the active tDCS group will improve episodic memory scores compared with the sham group; (2) differences on episodic memory scores will be shown between active BTC and lDLPFC and; (3) there will be significant delta reduction and an increase in alpha waves close to the location of the active electrodes compared with the sham group.Ethics and disseminationThis study was approved by Hospital das Clínicas, University of São Paulo Ethical Institutional Review Border (CAAE: 87954518.0.0000.0068).Trial registration numberNCT04540783.

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