背景:基于家庭的经颅直流电刺激(Hb-tDCS)是一种非侵入性脑刺激技术,利用通过头皮电极传递的低强度电流来调节大脑活动。它对于解决患有注意力缺陷/多动障碍(ADHD)的成年人的注意力不集中具有重要的希望。然而,它的有效性因个人而异,预测结果仍然不确定,部分是由于ADHD相关脑解剖的个体差异的影响。
方法:我们分析了来自子样本的数据,由29名成年多动症患者组成,成人多动症患者注意力不集中症状的治疗(TUNED)试验。14例患者接受了主动阳极右阴极左背外侧前额叶皮质(DLPFC)Hb-tDCS4周,15例接受了假手术相关的tDCS干预。在基线和终点(第4周)评估注意力不集中的结果。DLPFC的基线结构测量,前扣带皮质(ACC)和皮质下结构,以前与多动症有关,被量化了。几种线性混合模型,固定预测因子脑体积或厚度之间的三向相互作用,时间,和治疗进行了计算。使用Benjamini-Hochberg方法应用多个比较校正。
结果:左侧DLPFC区中额回的基线体积(t(25)=3.33,p调整=0.045,Cohen的d=1.33,95%CI=[0.45,2.19]),额下回(眶部)(t(25)=3.10,p-adjusted=0.045,Cohen\sd=1.24,95%CI=[0.37,2.08]),和左ACC的顺序(t(25)=3.15,p-adjusted=0.045,Cohen\sd=1.26,95%CI=[0.39,2.11])仅在活动性tDCS组中与注意力不集中得分改善显着相关。更具体地说,这些区域越小,经阳极右导管左DLPFCHb-tDCS后症状改善越多。
结论:Hb-tDCS与注意调节相关的脑区有更大的改善。脑MRI可用于预测ADHD成人对tDCS的临床反应。
BACKGROUND: Home-based transcranial direct current stimulation (Hb-tDCS) is a non-invasive brain stimulation technique that utilizes low-intensity electric currents delivered via scalp electrodes to modulate brain activity. It holds significant promise for addressing inattention in adults with attention-deficit/hyperactivity disorder (ADHD). However, its effectiveness varies among individuals, and predicting outcomes remains uncertain, partially due to the influence of individual differences in ADHD-related brain anatomy.
METHODS: We analyzed data from a subsample, composed by twenty-nine adult patients with ADHD, of the Treatment of Inattention Symptoms in Adult Patients with ADHD (TUNED) trial. Fourteen patients underwent active anodal right cathodal left dorsolateral prefrontal cortex (DLPFC) Hb-tDCS for 4 weeks and fifteen received sham-related tDCS intervention. Inattention outcome was evaluated at both baseline and endpoint (4th week). Baseline structural measures of the DLPFC, anterior cingulate cortex (ACC) and subcortical structures, previously associated with ADHD, were quantified. Several linear mixed models, with a three-way interaction between the fixed predictors brain volume or thickness, time, and treatment were calculated. Multiple comparison corrections were applied using the Benjamini-Hochberg method.
RESULTS: Baseline volume of the left DLPFC regions middle frontal gyrus (t (25) = 3.33, p-adjusted = 0.045, Cohen\'s d = 1.33, 95% CI = [0.45, 2.19]), inferior frontal gyrus (orbital part) (t (25) = 3.10, p-adjusted = 0.045, Cohen\'s d = 1.24, 95% CI = [0.37, 2.08]), and of the left ACC supragenual (t (25) = 3.15, p-adjusted = 0.045, Cohen\'s d = 1.26, 95% CI = [0.39, 2.11]) presented significant association with the inattentive score improvement only in the active tDCS group. More specifically, the smaller these regions were, the more the symptoms improved following anodal right cathodal left DLPFC Hb-tDCS.
CONCLUSIONS: Hb-tDCS was associated with greater improvement in brain areas related to attention regulation. Brain MRI can be potentially used to predict clinical response to tDCS in ADHD adults.