Repetitive Transcranial Magnetic Stimulation (rTMS): New Tool, New Therapy and New Hope for ADHD

Maria T. Acosta, Fidias E. Leon-Sarmiento

Disclosures

Curr Med Res Opin. 2003;19(2) 

In This Article

Summary and Introduction

Attention-deficit hyperactivity disorder (ADHD) is the most common developmental disorder that is associated with environmental and genetic factors. Neurobiological evidence suggests that fronto-striatum-cerebellum circuit abnormalities, mainly in the right hemisphere, are responsible for most of the disturbed sensorimotor integration; dopamine seems to be the main neurochemical alteration underlying these morphological abnormalities. Different conventional treatments have been employed on ADHD; however, repetitive transcranial magnetic stimulation (rTMS), a new and useful option for the clinical/research investigation of several neuropsychiatric disorders involving dopamine circuits, has yet to be considered as a therapeutic tool and possible drug-free option for ADHD. Here the authors explore the available evidence that makes this tool a rational therapeutic possibility for patients with ADHD, calling attention to safety issues, while highlighting the potentials of such an approach and the new hope it may bring for patients, parents, researchers and clinicians. The authors advocate carefully conducted clinical trials to investigate efficacy, safety, cost-effectiveness and clinical utility of rTMS for ADHD patients — in comparison to both placebo and standard treatments.

Attention-deficit hyperactivity disorder (ADHD) is the most common developmental disorder affecting at least 5% of school-aged children, with boys more frequently affected than girls.[1] It persists into adulthood in up to 60% of the cases.[2,3] It is characterised by inattention, impulsiveness and hyperactivity that impair normal daily life function, especially at home and school. The long-term consequences of childhood ADHD include lower educational and vocational outcomes as well as an increased risk for antisocial behavioural disorders and drug abuse in adulthood, among other psychopathologies.[4,5]

ADHD is a multifactorial disorder associated with environmental and genetic factors. Variations in brain size and morphology are present from early life, with fronto-striatum-cerebellum circuit abnormalities, mainly in the right hemisphere, considered responsible for most of the disturbed motor control and the abnormal sensory-motor programme;[3] dopamine seems to be the main neurochemical alteration underlying these morphological alterations. Based on these facts, stimulants of the nervous system are, to date, the most successful as well as the most controversial therapy employed.[6] Nevertheless, despite the enormous amount of research done, clinicians and parents are eagerly awaiting additional and better therapeutic options.

Magnetic stimulation is a recent and powerful non-invasive tool developed for studying the nervous system with promising findings on neural plasticity.[7,8,9] It is also currently being used to treat brain diseases, improving functional deficits and achieving noteworthy results in recent years.[9] This new tool has also been found useful in increasing the understanding of ADHD pathophysiology;[10,11] however, it has not been considered as a drug-free therapeutic option for treating ADHD. Therefore, we anticipate that if the rTMS effects on the dopaminergic system found in normals can be replicated in ADHD patients,[12] it could be the first step in offering new hope to patients, researchers and clinicians. Here we explore the available evidence that makes this option a viable possibility in the treatment of ADHD.

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