title: Transcranial magnetic stimulation (TMS) in the treatment of attention-deficit/hyperactivity disorder in adolescents and young adults: a pilot study.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: TMS Treatment and Research Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA. lgraves@mail.med.upenn.edu
authors.forename: Laurel
authors.initials: L
authors.lastname: Weaver
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Rostain
authors.forename: William
authors.initials: W
authors.lastname: Mace
authors.forename: Umair
authors.initials: U
authors.lastname: Akhtar
authors.forename: Edward
authors.initials: E
authors.lastname: Moss
authors.forename: John P
authors.initials: JP
authors.lastname: O'Reardon
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000523:psychology / Q000628:therapy*; D001299:Audiometry; D018592:Cross-Over Studies; D004569:Electroencephalography; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D001523:Mental Disorders / Q000150:complications; D009483:Neuropsychological Tests; D010865:Pilot Projects; D017397:Prefrontal Cortex / Q000502:physiology; D011569:Psychiatric Status Rating Scales; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult