Spreading Effect of tDCS in Individuals with Attention-Deficit/Hyperactivity Disorder as Shown by Functional Cortical Networks: A Randomized, Double-Blind, Sham-Controlled Trial

Camila Cosmo, Cândida Ferreira, José Garcia Vivas Miranda, Raphael Silva do Rosário, Abrahão Fontes Baptista, Pedro Montoya, Eduardo Pondé de Sena, Camila Cosmo, Cândida Ferreira, José Garcia Vivas Miranda, Raphael Silva do Rosário, Abrahão Fontes Baptista, Pedro Montoya, Eduardo Pondé de Sena

Abstract

Background: Transcranial direct current stimulation (tDCS) is known to modulate spontaneous neural network excitability. The cognitive improvement observed in previous trials raises the potential of this technique as a possible therapeutic tool for use in attention-deficit/hyperactivity disorder (ADHD) population. However, to explore the potential of this technique as a treatment approach, the functional parameters of brain connectivity and the extent of its effects need to be more fully investigated.

Objective: The aim of this study was to investigate a functional cortical network (FCN) model based on electroencephalographic activity for studying the dynamic patterns of brain connectivity modulated by tDCS and the distribution of its effects in individuals with ADHD.

Methods: Sixty ADHD patients participated in a parallel, randomized, double-blind, sham-controlled trial. Individuals underwent a single session of sham or anodal tDCS at 1 mA of current intensity over the left dorsolateral prefrontal cortex for 20 min. The acute effects of stimulation on brain connectivity were assessed using the FCN model based on electroencephalography activity.

Results: Comparing the weighted node degree within groups prior to and following the intervention, a statistically significant difference was found in the electrodes located on the target and correlated areas in the active group (p < 0.05), while no statistically significant results were found in the sham group (p ≥ 0.05; paired-sample Wilcoxon signed-rank test).

Conclusion: Anodal tDCS increased functional brain connectivity in individuals with ADHD compared to data recorded in the baseline resting state. In addition, although some studies have suggested that the effects of tDCS are selective, the present findings show that its modulatory activity spreads. Further studies need to be performed to investigate the dynamic patterns and physiological mechanisms underlying the modulatory effects of tDCS.

Trial registration: ClinicalTrials.gov NCT01968512.

Keywords: attention-deficit/hyperactivity disorder; dorsolateral prefrontal cortex; functional cortical networks; spreading effect; transcranial direct current stimulation.

Figures

Figure 1
Figure 1
Study flowchart adapted from CONSORT flow diagram.
Figure 2
Figure 2
(A) Sliding time window over the EEG time series; (B) Correlation matrix for each time window; (C) After the threshold criterion, the correlation matrices were transformed into a 0 or 1 adjacent matrix, which summed throughout the whole time interval result in the Added Static Network (ASN).
Figure 3
Figure 3
Box plot representing the weighted node degree by group (active vs. sham) and time (pre vs. post intervention). No significant differences were found between the groups before and after the interventions (p ≥ 0.05).
Figure 4
Figure 4
Illustration of the result by electrode. The paired-sample Wilcoxon signed-rank test was used to compare the weighted node degree, pre- and post-intervention, within groups. A statistically significant difference was observed in the active group (p < 0.05) while no statistically significant differences were found in the sham intervention (p ≥ 0.05).

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