Trigeminal nerve stimulation (TNS), which is currently approved in Canada and Europe to treat adults with medication-resistant seizures and depression, has been shown to be a safe and effective treatment for children with attention deficit disorder (ADHD). This was revealed in a study published in April 2019 issue. Journal of the American Academy of Child and Adolescent Psychiatry.
TNS uses a small stimulator that is worn on the clothing of a child to produce a low-level current. It is powered by a 9-volt lithium battery. The device is connected to thin wires via an adhesive electrode patch that is worn across the forehead while sleeping. The child may not be aware of the slight stimulation, but it activated deeper brain areas involved in impulse control and concentration. The patches were worn by children for an average of eight hours each night and were removed each morning.
“ADHD is estimated to affect 9.5 percent of school-age children and 4.4 percent of adults,” said James McGough, MD, Professor and child psychiatrist at the Jane & Terry Semel Institute for Neuroscience and Human Behavior at University of California, Los Angeles, CA, USA. “Our current treatments mostly rely on medication with some role to behavioral therapies. There is a lot of demand for ADHD treatments that are not medication-based, but the best options have very little, if any, scientific support.
Investigators recruited 62 children between 8 and 12 years old to test their TNS. They randomly assigned them to receive either active or sham TNS every night for four weeks. The first week of treatment showed significant benefits, with an increase in improvement over the subsequent weeks. The ADHD-Rating Scale, p =.005, and the Clinical Global Impression – Improvement scale (p =.003), which were the primary outcomes of the study, showed improvement. The treatment effect was comparable to that of FDA-approved nonstimulant ADHD medications.
In addition to reductions in behavioral ADHD symptoms, investigators found positive changes in brain activation with active TNS, measured by electroencephalography (EEG). This finding is consistent NIMH research priorities. It highlights measurable changes and behavioral improvements in neurological functioning. It also suggests that TNS can have beneficial effects on brain circuits that regulate hyperactivity and impulsivity. TNS may also be effective in reducing anxiety symptoms for children, according to other studies on TNS for adult depression or post-traumatic stress disorder.
Many studies of non-medication ADHD treatments have a major drawback: it is difficult to maintain effective blinding of the sham condition. The study’s investigators found that parents of children in active and sham TNS groups had the same expectation of benefit after the first week. This suggests that the study design effectively concealed the treatment their children were receiving. This, along with differences in brain activation measured using EEG, supports the conclusion of the study regarding the potential use of TNS for ADHD therapy.
Dr. McGough, who was the principal author of the study, said that he was excited to see significant improvements in brain functioning and ADHD symptoms. “The treatment was well-received by patients and their families. Compliance was high and there were no clinically relevant side effects. TNS offers great potential for ADHD management.
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