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July2014 Vol.51 Issue:      3 (Supp.) Table of Contents
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Efficacy and Attributes of Repetitive Transcranial Magnetic Stimulation (rTMS) in Treatment of a Sample of Children with Attention Deficit Hyperactivity Disorder (ADHD)

Iman M. Bayoumy1, Salma H. Khaleel1, Maha Nada1, Mona Ibraheem Awaad2,

Doaa Khalifa2, Hesham Hatata2

Departments of Neurology1, Psychiatry2, Ain Shams University; Egypt



ABSTRACT

Background: Attention deficit hyperactivity disorder (ADHD) is a syndrome that affects children. Repetitive transcranial magnetic stimulation (rTMS) can produce effects on dopaminergic system similar to effects of D-amphetamine. Objective: To evaluate efficacy of rTMS as a therapeutic modality in ADHD in children. Methods: This study was conducted on 41 ADHD children. All patients were subjected to clinical psychiatric and psychometric assessment using Kiddie Schedule, Wechsler Intelligence Scale and Conners’ Parent Rating Scale Revised Long-version (CPRS-R-L). Neurological assessment by diagnostic TMS, Physical and Neurological Examination for Soft Signs (PANESS) scale for neurological soft signs, and conventional EEG were done before and after rTMS given at low frequency 1Hz, 1200stimuli/day for five days. Results: EEG showed increased beta activity in 26 cases (63.4%) after rTMS. Highly significant reductions were found in all studied dimensions except perfectionism scale and psychosomatic scale. Females showed higher percent of change in psychosomatic subscale and ipsilateral silent period (ISP) latency. Boys showed significant reduction of oppositional attitude and hyperactivity. Hyperactivity and ISP duration showed significant correlation with older ages. Highly significant difference in the anxious shy was found in the inattentive subtype. Social problems showed significant change in the combined type. Psychosomatic dimension was significantly increased in the inattentive compared to combined type. ISP latency showed significant change on correlating inattentive with hyperactive impulsive type. Conclusion: Most of the used tests showed significant results but the higher difference in diagnostic TMS and PANESS scale makes them superior over psychometric tests in evaluating rTMS therapy. [Egypt J Neurol Psychiat Neurosurg.  2014 ; 51(3): 361-367]


Key Words: ADHD, rTMS, diagnostic TMS, Conners scale, Kiddie schedule, PANESS scale.

 Correspondence to Iman Bayoumy, Neurology Department, Ain Shams University, Egypt. Tel.: +201002595522.       Email: imanbayomy@yahoo.com





 

INTRODUCTION

 

Attention deficit hyperactivity disorder (ADHD) is a syndrome that affects around 5% of school-aged children.1 Stimulants of the nervous system (as D-amphetamine) through mediation of the dopamine system comprise evidence-based therapy for ADHD.1 Stimulants however have multiple side effects2. Many Studies have shown that repetitive TMS (rTMS) can produce effects on the dopaminergic system in healthy subjects similar to the effects of D-amphetamine.3

Aim of work: To evaluate the efficacy of rTMS as a therapeutic modality in the treatment of ADHD in children, to study the various clinical dimensions and demographic variables that showed improvement after application of therapeutic TMS sessions, and to assess its ease of use in children and adolescents.

 

PATIENTS AND METHODS

 

This study was conducted on 41 ADHD children with age ranging from 6-15 years and all were right handed. All patients were recruited from the child and adolescent psychiatry clinic in the Institute of Psychiatry, Ain-shams University during the period from July 2012 to July 2013. A written consent was obtained from the parents with assent of the participating children. All patients had to fulfill the preset inclusion criteria of having ADHD with no associated other psychiatric or neurological disorders, epilepsy or medical comorbidities and having an intelligence quotient (IQ)> 80. They were medication-naïve patients and both genders were included. Ethical approval was obtained.

Patients were instructed to start rTMS sessions within 3 days of pre TMS neuropsychiatric evaluation sessions and to have the post TMS evaluation sessions within maximally 3 days to avoid alteration of the condition and confounding the results.

rTMS protocol (low frequency 1 Hz, 1200 stimuli/day for five days) was chosen over the single high frequency protocol due to its higher safety and tolerability in children with significant improvements lasting up to four weeks.1

Diagnosis of ADHD was ascertained using Kiddie Schedule for Affective Disorders and Schizophrenia, present and lifetime version (K-SADS-PL, Kaufman and colleagues).4K-SADS-PL is an interviewer-based, semi-structured interview for children aged between 6 and 18 years. The Arabic version of the K-SADS-PL used in this study was translated and validated through a previous research.5

Intelligence level was assessed using the Wechsler Intelligence Scale for Children (WISC), Arabic version was administered by a trained clinical psychologist to assess the intellectual abilities and cognitive functions of the children.6

Severity ratings of ADHD was established using the Conners’ Parent Rating Scale Revised- Long -Version (CPRS-R-L) which was administered by the psychiatrists participating in this study twice, pre and post TMS administration. This is an80 question rating scale that assesses the severity of ADHD; responses are scored on a 4-point likert scale based on the frequency of occurrence from 0 (not true) to 3 (very true). It is divided into several clinical dimensions as oppositional behavior, cognitive and inattentive problems, hyperactivity, anxious-shy scale, perfectionism, social problems and psychosomatic problems, in addition to validity dimensions as the ADHD index and DSM inattentive, hyperactive-impulsive and total subscales7. The Arabic version of CPRS-R-L used in this study was translated by Elsheikh and colleagues, 2003 and validated through its use in previous studies.8

rTMS and diagnostic TMS were done using a Dantecmaglite stimulator connected to Dantec counter point EMG machine. A figure of eight coil was used to stimulate the right dorsolateral prefrontal cortex located by measuring 5cm anterior to the motor threshold.9 Therapeutic rTMS was given at low frequency (1 Hz), 1200 stimuli/session for 5 days.1Diagnostic TMS was done. Appropriate intensity was reached where three of six evoked small motor-evoked potentials (approximately 50µv amplitude motor evoked potentials in resting muscle).10 The primary physiologic measure of interest was the ipsilateral silent period (ISP) latency and duration. The latency involves the time interval from the TMS pulse to the onset of the ISP. The duration involves the time interval between the onset and offset of the ISP.10

Motor skills assessments: The children were rated using Physical and Neurological Examination for Soft Signs (PANESS). The PANESS measures salient components of motor function, including lateral preference, gaits, balance, motor persistence, coordination, overflow, dysrhythmia, and timed movements. Three primary outcome variables were used in the current study; (a) Total speed of timed movements of the hands/feet was measured from six sets of timed activities, each performed bilaterally, (b) Total overflow included the total number of abnormal-for age, awkward posturing of arms, hands or body movements observed during stressed gaits, tandem gaits as well as during timed movements, and (c) Total dysrhythmia included the total number of timed motor examination trials in which the child failed to maintain steady rhythm of the task.11

Conventional EEG was done using 16 channels digital EEG machine (Nihon Khoden) with scalp electrodes applied according to the 10-20 system to detect the β wave activity pre- and post-rTMS and exclude epileptic activity prior to treatment.

 

Statistical Analysis

Continuous variables were expressed as mean and standard deviation. Categorical variables were expressed as frequencies and percentages. Paired t-test was used to assess the statistical significance of the difference between pre and post measurements. Continuous variables were compared using ANOVA or student t test. Pearson correlation was used to assess the correlation between continuous variables. A significance level of P<0.05 was used in all tests. All statistical procedures were carried out using SPSS version 15 for windows (SPSS Inc, Chicago, IL, USA).

 

RESULTS

 

Forty-one patients with a mean age of 9.39±2.34 years participated in this study. Twenty five were males (61%) and 16 were females (39%). The mean age of onset of ADHD was 4.63±1.09 years and the mean duration of illness was 4.12±2.09 years. The three types of ADHD were included in the study, combined, 28 cases (68.3%), inattentive, seven (17.1%) and hyperactive-impulsive type, Six cases (14.6%) of cases. The mean verbal IQ level of the sample was 112.39±14.1, whereas the performance IQ was 103.3±14.1, and the total IQ level was 109.8±10.2. EEG showed changes in 26 cases (63.4%) in the form of increased beta activity after rTMS.

Comparison of the psychiatric and neurological parameters before and after rTMS therapy revealed highly significant reductions in all studied dimensions except perfectionism scale (p=0.383) and psychosomatic scale (p=0.87) were non-significant (Table 1).

Total dysrhythmia showed the highest percent of change after treatment, as it showed 18.5% decrease from baseline level; this was followed by total overflow (17.8%). Psychosomatic subscale and perfectionism showed elevation in their levels compared to baseline level with 0.16% and 0.5% respectively, both of which reflect increased levels of anxiety post TMS.

Comparing males to females regarding the percent of change after rTMS, psychosomatic subscale and ISP latency change showed highly significant results with p<0.001. Females showed higher percent of change in both parameters indicating that girls were more prone to experience pains, somatic complaints and headaches than boys with ADHD. Oppositional scale change, hyperactivity, total time motor change showed significant results, which indicated that, the percentage of reduction of oppositional attitude and hyperactivity changed significantly in ADHD boys than ADHD girls. Otherwise, other parameters showed non-significant change (Table 2).

On analysis of the effect of age, hyperactivity and ISP duration showed significant positive correlation with older ages denoting that the mean change in hyperactivity subscale was higher with older ADHD patients (table 3). ISP duration showed a significant change (p=0.021) with prolongation of ADHD duration (Table 3).

We compared further the effect of ADHD type on the improvement of the clinical dimensions. We found that the change in the anxious-shy dimension showed highly significant statistical difference in the inattentive subtype compared to the hyperactive impulsive or combined type denoting that children with the inattentive subtype showed the best reduction in their anxiety and shyness. Similarly social problems showed significant change (p=0.02) in the combined compared to the inattentive type. Psychosomatic dimension significantly increased in the inattentive compared to the combined type (p=0.005).ISP latency showed significant change on correlating the combined with the hyperactive impulsive type (Table 4).


 

Table 1. Comparison of the neurological and psychiatric variables pre and post therapeutic TMS among patients.

 

Studied dimensions

pre- and post-TMS

Pre TMS dimensions

Post TMS dimensions

P

Mean

±SD

Mean

±SD

Oppositional scale

68.98

4.447

66.63

3.666

0.0001*

Inattention

78.68

6.109

72.15

6.259

0.0001*

Hyperactivity

77.73

8.438

71.95

8.255

0.0001*

Anxious shy

66.22

3.103

64.22

2.937

0.0001*

Perfectionism

55.90

3.520

56.15

3.358

0.383

Social problems

74.02

5.179

70.56

3.722

0.0001*

Psychosomatic

58.15

3.490

58.20

3.265

0.870

ADHD index

79.32

5.410

71.49

3.880

0.0001*

CGI

78.68

5.926

72.46

5.249

0.0001*

DSM inattention

76.54

5.381

70.02

5.027

0.0001*

DSM hyperactivity

74.39

4.903

68.76

4.381

0.0001*

DSM combined

76.32

5.606

69.80

5.311

0.0001*

ISP latency

45.85

3.198

43.59

3.090

0.0001*

ISP duration

10.12

5.183

9.98

4.356

0.657

CMCT amplitude

50.00

0.000

50.56

0.808

0.0001*

Total time motor

81.54

10.159

79.34

9.999

0.0001*

Total overflow motor

8.46

2.916

7.05

2.729

0.0001*

Total dysrhythmia motor

4.48

1.867

3.62

1.532

0.0001*

CGI Conners Global index, ISP Ipsilateral silent period, CMCT Central motor conduction time.

*Significant at P<0.01

Table 2. Comparison of gender differences regarding changes of clinical and neurological dimensions post rTMS.

 

Studied dimensions pre and post rTMS

Changes in studied dimensions

P-value

Male

 

Female

Mean

±SD

Mean

±SD

Oppositional scale change

4.11

2.92

2.04

1.85

0.016*

Inattention change

7.20

8.23

9.63

2.01

0.169

Hyperactivity change

6.79

1.93

8.51

2.37

0.022*

Anxious shy change

3.12

2.18

2.79

2.20

0.637

Perfectionism change

-0.88

4.07

0.07

1.87

0.384

Social problems change

5.17

3.54

3.53

1.95

0.064

Psychosomatic change

1.24

3.26

-2.34

1.69

<0.001**

ADHD index change

9.48

5.37

10.01

1.84

0.706

CGI change

7.85

3.86

7.80

1.67

0.963

DSM inattention change

8.10

4.29

8.96

2.60

0.477

DSM hyperactivity change

8.06

2.93

6.69

1.87

0.103

DSM combined change

8.41

4.07

8.57

3.11

0.882

ISP latency change

3.01

4.49

7.74

2.49

<0.001**

ISP duration change

-4.68

30.53

-9.56

22.45

0.586

CMCT amplitude change

-1.04

1.54

-1.25

1.77

0.690

Total time motor change

1.45

5.72

4.45

1.00

0.046*

Total overflow motor change

14.31

7.33

23.29

12.89

0.019*

Total dysrhythmia motor change

16.41

5.61

21.92

11.48

0.089

CGI Conners Global index, ISP Ipsilateral silent period, CMCT Central motor conduction time.

*Significant at P<0.05 **Significant at P<0.01

 

Table 3. Correlation between Age, Duration of ADHD and changes of the studied dimensions.

 

Studied dimensions

Age

 

Duration

R

P

R

P

Oppositional scale change

0.082

0.61

0.032

0.841

Inattention change

-0.163

0.309

-0.215

0.177

Hyperactivity change

0.330

0.035*

0.233

0.143

Anxious shy change

0.043

0.791

0.102

0.528

Perfectionism change

-0.098

0.542

-0.214

0.179

Social problems change

0.295

0.062

0.208

0.192

Psychosomatic change

0.086

0.595

-0.028

0.864

ADHD index change

0.160

0.318

0.030

0.850

CGI change

0.229

0.149

0.081

0.614

DSM inattention change

-0.054

0.738

-0.105

0.514

DSM hyperactivity change

-0.052

0.748

-0.097

0.546

DSM combined change

0.026

0.872

-0.045

0.781

ISP latency change

0.162

0.312

0.152

0.342

ISP duration change

-0.527

0.0001**

-0.360

0.021*

CMCT amplitude change

-0.080

0.621

-0.181

0.258

Total time motor change

0.125

0.435

0.158

0.324

Total over flow motor change

0.014

0.931

0.087

0.590

Total dysrhythmia motor change

-0.210

0.187

0.012

0.939

CGI Conners Global index, ISP Ipsilateral silent period, CMCT Central motor conduction time.

*Significant at P<0.05 **Significant at P<0.01

Table 4. Comparison between ADHD types regarding changes of the studied dimensions.

 

Changes of the studied dimensions

Type of ADHD

P*

Post hoc test

Combined

(Gr1)

Inattentive

(Gr2)

Hyperactive impulsive

(Gr3)

Mean

±SD

Mean

±SD

Mean

±SD

Oppositional scale change

3.43

2.14

3.30

4.64

2.73

2.92

0.858

 

Inattention change

8.78

4.33

6.03

13.69

7.66

3.64

0.614

 

Hyperactivity change

7.70

2.04

6.19

2.13

7.85

3.13

0.260

 

Anxious shy change

2.87

1.79

5.24

1.10

0.93

2.57

0.001**

Gr1 Vs Gr2a

Gr 2 Vs Gr3b

Perfectionism change

-.09

3.00

-1.79

5.55

-0.99

1.63

0.473

 

Social problems change

5.24

3.05

1.66

2.62

4.54

2.00

0.020*

Gr1 Vs Gr2a

Psychosomatic change

.81

3.27

-3.41

0.13

-0.91

2.48

0.005**

Gr1 Vs Gr2b

ADHD index change

10.67

3.27

8.09

7.52

6.98

2.39

0.090

 

CGI change

8.19

3.29

6.05

3.24

8.24

1.88

0.267

 

DSM inattention change

8.78

3.13

8.68

5.92

6.52

3.13

0.400

 

DSM hyperactivity change

7.36

2.94

7.90

1.75

7.87

2.08

0.841

 

DSM combined change

8.93

3.80

9.43

2.65

5.22

2.68

0.058

 

ISP latency change

4.10

4.26

4.01

4.45

9.36

2.86

0.023*

Gr1 Vs Gr3a

ISP duration change

-6.90

25.89

-14.88

39.37

4.53

17.57

0.455

 

CMCT amplitude change

-0.93

1.49

-1.43

1.90

-1.67

1.97

0.525

 

Total time motor change

2.26

5.62

3.58

1.54

3.16

1.32

0.776

 

Total over flow motor change

17.60

12.06

19.00

8.69

17.45

5.94

0.952

 

Total dysrhythmia motor change

18.51

8.43

20.65

4.82

16.39

13.53

0.689

 

ANOVA test was used, apost hoc test, bpost hoc test 

CGI Conners Global index, CMCT Central motor conduction time, ISP Ipsilateral silent period

*Significant at P<0.05 **Significant at P<0.01

 


DISCUSSION

 

In the present study, we aimed to examine the possible amelioration in ADHD symptoms by stimulating the right prefrontal cortex with a course of rTMS.3

We chose the dorsolateral prefrontal cortex due to its major role in the pathophysiology of ADHD and its effect on the modulation of neurotransmitters specifically dopamine and its metaboloites.9Our results showed that all parameters used in this study gave significant changes after using rTMS except perfectionism scale (p=0.383) and psychosomatic scale (p=0.87) that showed non-significant results. These results were partially in agreement with Weaver and his colleagues12, and Neiderhofer1, who showed improvement over the mean Clinical Global Impression-Improvement and the ADHD-IV scales for at least 4 weeks.

In all studied patients, total dysrhythmia showed the highest percentage of change after treatment with 18.5% decrease from baseline level followed by total overflow motor change (17.8%). ISP duration showed higher percent of elevation after treatment (6.9%) than ISP latency (4.86%). These results go with other studies showing altered ISP in persons with lesions of the corpus callosum.13 While Garvey and colleagues14 and Larson and colleagues15 had a different finding. They found that ISP latency was the finding related to the transcallosal inhibition considered necessary for suppressing motor overflow. They also found that there is poor improvement with age in boys with ADHD because of delay in development of inter-hemispheric connections important for transcallosal inhibition. This explains the less significant results in psychosomatic change and ISP latency change after rTMS in boys in comparison to girls.

So, girls typically present with more inattentive symptoms of ADHD, while boys show more hyperactive impulsive symptoms.16 Motor examination maybe more sensitive to detect abnormalities associated with hyperactivity. This reflects problems with control of unwanted movements and are more strongly tied to motor control. The only sign that come in contrast to previous studies was the significant hyperactivity change being better in girls. Previous studies showed that girls usually present with inattention while boys present with hyperactivity.16But even this finding can be explained by the fact that motor control is earlier in girls by 1 year, which makes way for the better improvement in girls. Hyperactivity and ISP duration showed significant change with progression of age. These findings correlate with those of Cole and colleagues11that found that the speed of responding improves with age. Also, multiple MRI studies showed abnormalities in regions important for motor control such as frontal cortex, premotor and motor regions17and interconnected subcortical structures in children with ADHD.18

The ISP duration showed a significant change with prolongation of the ADHD duration. This finding was not discussed in previous researches. Most of the previous researches correlated this to severity of ADHD or progression of age.11

On correlating the different types of ADHD with the percent of change, it was found that the inattentive type gave the best improvement on the anxious shy change on comparing it to the hyperactive and the combined types. Also inattentive gave significant results on comparing it to combined type in the perfectionism and psychosomatic change. These findings can be explained by the findings of Garvey and colleagues19, who found out that attention disorders are caused by impairments in fronto-striatal circuits. Since the application of rTMS is to this site, so improvement is caused by rTMS to fronto-striatal circuits. ISP latency showed significant changes on comparing the combined type to the hyperactive type of ADHD showing better improvement in the hyperactive type. This finding can be explained by the results of Garvey and colleagues14, who found that ISP latency was related to the transcallosal inhibition necessary for suppressing motor overflow. Patankar and colleagues20 found that dysrrhythmias and overflow with gait were typically seen for impulsive hyperactive type and higher severity of ADHD is related to more errors. Hence, ISP latency is more affected in the hyperactive type.

EEG showed increased beta activity after rTMS in 26 cases (63.4%) which is supported by the findings of Snyder and Hall (2006).21They found that theta/ beta ratio increase is a commonly observed trait in ADHD with increase in the beta activity decreasing the theta/beta ratio with improvement of the condition.

 

Conclusion

Most of the used tests showed significant results but the PANESS scale with its subtests total dysrhythmia and total overflow showed the most statistically significant improvement. The TMS findings mainly ISP latency and duration showed highly significant results that are higher with age and between both genders (higher in females) and between types of ADHD; higher in hyperactive type. Therefore, this makes diagnostic TMS and PANESS scale more superior tests than psychometric tests in evaluating rTMS therapy. The results of this study could encourage future research on amelioration of ADHD symptomatology by using rTMS directed to the right dorsolateral prefrontal cortex.

 

[Disclosure: Authors report no conflict of interest]

 

REFERENCES

 

1.        Niederhofer H. Effectiveness of the repetitive Transcranial Magnetic Stimulation (rTMS) of 1 Hz for Attention-Deficit Hyperactivity Disorder (ADHD). Psychiatr Danub. 2008; 20(1): 91-2.

2.        Mészáros A, Czobor P, Bálint S, Komlósi S, Simon V, Bitter I. Pharmacotherapy of adult attention deficit hyperactivity disorder (ADHD): a meta-analysis. Int J Neuropsychopharmacol. 2009; 12(8): 1137-47.

3.        Pogarell O, Koch W, Pöpperl G, Tatsch K, Jakob F, Mulert C, et al. Acute prefrontal rTMS increases striatal dopamine to a similar degree as D-amphetamine. Psychiatry Res. 2007;156(3):251-5.

4.        Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997; 36: 980-8.

5.        Ibrahim M, Bishry Z, Khaleel A, Ghanem M, Sheehan D, Sheehan K. Comparison of the MINI-kid with K-SADS-PL for school aged children in an Egyptian sample presented with childhood disorders [MD thesis]. Cairo (Egypt): Ain Shams University; 2002.238p.

6.        Ismail ME, Meleka L. Wechsler-Bellevue Intelligence scale.7th ed. Cairo: Nahdit Misr Press; 1999.

7.        Conners CK. Conners Rating Scales–revised. North Tonawanda, New York: Multi-Health Systems; 2001.

8.        El Sheikh MM, Sadek A, Omar AN, El Nahass G. Psychiatric morbidity in first degree relatives of a sample of ADHD children [MD thesis].Cairo (Egypt): Ain Shams University; 2003.247p.

9.        Bloch Y, Harel EV, Aviram S, Govezensky J, Ratzoni G, Levkovitz Y. study. World J Biol Psychiatry.2010;11(5):755-8.

10.     Wu SW, Gilbert DL, Shahana N, Huddleston DA, Mostofsky SH. Transcranial magnetic stimulation measures in attention deficit/ hyperactivity disorder. Pediatr Neurol. 2012; 47(3):177-85.

11.     Cole WR, Mostofsky SH, Larson JCG, Denckla MB, Mahone EM. Age related changes in motor subtle signs among girls and boys with ADHD. Neurology. 2008;71:1514-20

12.     Weaver L, Rostain AL, Mace W, Akhtar U, Moss E, O'Reardon JP. Transcranial magnetic stimulation (TMS) in the treatment of attention-deficit/hyperactivity disorder in adolescents and young adults: a pilot study. J ECT. 2012;28(2):98-103.

13.     Voineskos AN, Farzan F, Barr MS, Lobaugh NJ, Mulsant BH, Chen R, et al.. The role of the corpus callosum in transcranial magnetic stimulation induced interhemispheric signal propagation. Biol Psychiatry.2010;68:825-31.

14.     Garvey MA, Barker CA, Bartko JJ, Denckla MB, Wassermann EM, Castellanos FX, et al. The ipsilateral silent period in boys with attention-deficit/hyperactivity disorder.ClinNeurophysiol.2005;116:1889-96.

15.     Larson J, Mostofsky SH, Goldberg MC, Cutting LE, Denckla MB, Mahone EM. Effects of gender and age on motor exam in developing children. Dev Neuropsychol. 2007;543-62.

16.      Hinshaw SP, Owens EB, Sami N, Fargeon S. Prospective follow-up of girls with attention deficit/hyperactivity disorder into adolescence: Evidence for continuing cross-domain impairment. J Consult Clin Psychol. 2006;74:489-99. 

17.     Mostofsky SH, Cooper KL, Kates WR, Denckla MB, Kaufmann WE. Smaller prefrontal and premotor volumes in boys with ADHD. Biol Psychiatry. 2002;52:785-94. 

18.     Wellington TM, Semrud-Clikeman M, Gregory AL, Murphy JM, Lancaster JL.Magnetic resonance imaging volumetric analysis of the putamen in children with ADHD: combined type versus control. J Atten Disord. 2006;10:171-80.

19.     Garvey MA, Ziemann U, Bartko JJ, Denckla MB, Barker CA, Wassermann EM. Cortical correlates of neuromotor development in healthy children. ClinNeurophysiol.2003;114:1662-70.

20.     Patankar VC, Sangle JP, Shah HR, Dave M, Kamath RM. Neurological soft signs in children with attention deficit hyperactivity disorder. Indian J Psychiatry. 2012; 54(2): 159-65.

21.     Snyder SM, Hall JR. A meta-analysis of quantitative EEG power associated with attention deficit hyperactivity disorder. J Clin Neurophysiol. 2006; 23(5):440-55.


 

 

الملخص العربى

 

فعالية وسمات التنبيه المغناطيسى المتكرر عبر الجمجمة فى علاج عينة من الأطفال المصابين بفرط الحركة و نقص الانتباه

 

فرط الحركة ونقص الانتباه متلازمة تؤثر على الأطفال فى سن الدراسة. كثير من الدراسات أظهرت أن التنبيه المغناطيسى المتكرر عبر الجمجمة يمكن ان يحدث تأثير على نظام الدوبامين يماثل تأثير د-امفيتامين. يهدف البحث إلى تقييم كفاءة التنبيه المغناطيسى المتكرر عبر الجمجمة كوسيلة لعلاج فرط الحركة ونقص الانتباه فى الأطفال. تم إجراء هذه الدراسة على 41 طفل يعانون من فرط الحركة ونقص الانتباه.خضع الأطفال للاختبارات النفسية الإكلينيكية والقياسات النفسية الآتية: مقياس كيددي, مقياس وكسلر للذكاء ومقياس كونرز المطول. يشمل التقييم العصبى: التنبيه المغناطيسي عبر الجمجمة التشخيصي، مقياس بانس للعلامات العصبية الضعيفة ورسم المخ التقليدي وتم عمل هذه الاختبارات. قبل وبعد التنبيه المغناطيسى المتكرر عبر الجمجمة الذي تم إعطاؤه على تردد منخفض لمدة 5 أيام. أظهرت نتائج رسم المخ زيادة فى نشاط بيتا فى 26 حالة (63.4%) بعد التنبيه المغناطيسي المتكرر عبر الجمجمة كما وجد انخفاض ذو قيمة احصائية عالية فى جميع الأبعاد المدروسة ما عدا مقياس الكمال والمقياس النفسجسمى. وأظهرت الإناث نسبة أعلى من التغير فى المقياس النفسجسمى وكمون الفترة الساكنة على نفس الجهة.اظهر الذكور انخفاض ذو قيمة احصائية فى اختبارات موقف المعارضة وفرط الحركة. اختبارات فرط الحركة ومدة الفترة الساكنة على نفس الجهة اظهروا علاقة ذات دلالة احصائية مع السن الأكبر. اظهر النوع الغير منتبه فارق ذو دلالة إحصائية عالية فى القلق والخجل. اظهر النوع المشترك فارق ذو دلالة احصائية فى المشاكل الاجتماعية. أظهر النوع الغير منتبه زيادة ذات دلالة احصائية في الأبعاد النفسجسمية. وكمون الفترة الساكنة على نفس الجهة اظهر فارق ذات دلالة احصائية عند مقارنة النوع الغير منتبه بالنوع المفرط الحركة المندفع. خلاصة هذا البحث أن معظم الاختبارات المستخدمة أظهرت نتائج ذات دلالة احصائية ولكن الفرق الأكبر كان فى التنبيه المغناطيسى عبر الجمجمة التشخيصى ومقياس بانس للعلامات العصبية الضعيفة مما يجعلهم أعلى قيمة من القياسات النفسية في تقييم كفاءة التنبيه المغناطيسي المتكرر عبر الجمجمة كوسيلة للعلاج.



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