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Transcranial Magnetic Stimulation (TMS) in the Treatment of Attention-Deficit/Hyperactivity Disorder in Adolescents and Young Adults: A Pilot Study

Weaver, Laurel MD, PhD; Rostain, Anthony L. MD, MA; Mace, William PhD; Akhtar, Umair MD; Moss, Edward PhD; O’Reardon, John P. MD

doi: 10.1097/YCT.0b013e31824532c8
Original Studies

Objective: Transcranial magnetic stimulation (TMS) uses a medical device that applies magnetic pulses noninvasively to the cortex of the brain to depolarize neurons. We tested its safety and efficacy in young persons with a diagnosis of attention-deficit/hyperactivity disorder (ADHD).

Methods: Transcranial magnetic stimulation was applied to the right prefrontal cortex at 10 Hz, at 100% of the observed motor threshold, for 2000 pulses per session, in a 10-session course over 2 weeks in a sham-controlled crossover design (n = 9). There was 1 week of no TMS between the active and sham phases. Safety of TMS was assessed by means of serial audiometry, neuropsychological testing, and electroencephalogram (EEG) at baseline, midpoint, and end point of the study. Efficacy was assessed as a primary outcome by changes in the Clinical Global Impression—Improvement (CGI-I) scale and secondarily by change in the ADHD-IV scale.

Results: Transcranial magnetic stimulation was found to be safe, with no serious adverse events and no discontinuations due to adverse effects. All randomized subjects completed the full course of sessions. There were no significant changes in auditory thresholds or in electroencephalographic assessments. Neuropsychological testing showed no significant differences between active and sham groups. There was an overall significant improvement in the clinical global impression of improvement and the ADHD-IV scales across the study phases (active and sham TMS combined; P < 0.01), but the change between active and sham TMS phases did not differ.

Conclusion: Transcranial magnetic stimulation was found to be safe, with no serious adverse events observed in this pilot study. Improvement in symptoms was observed across the combined phases of the study, although there was no difference between the active and sham forms of TMS. Effects of clinical importance should be further assessed in larger controlled studies.

From the TMS Treatment and Research Program and Adult ADHD Treatment and Research Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.

Received for publication June 9, 2011; accepted December 5, 2011.

Reprints: Laurel Weaver, MD, PhD, Department of Child and Adolescent Psychiatry, The Children’s Hospital of Philadelphia, 2nd Floor, 3440 Market St, Philadelphia, PA 19104 (e-mail: lgraves@mail.med.upenn.edu).

Dr Rostain is a consultant to Shire and to Ortho-McNeill-Janssen.

The authors have no conflict of interest to declare.

Parker Fund supported the research for this work.

TMS device support was furnished in part by Magstim Ltd, UK.

Results of this study were presented in preliminary format at the Association for Convulsive Therapy 2008 Annual Meeting, May 4, 2008, Washington, DC.

© 2012 by Lippincott Williams & Wilkins