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Clinical effects of repetitive transcranial magnetic stimulation combined with atomoxetine in the treatment of attention-deficit hyperactivity disorder

Authors Cao P, Xing J, Cao Y, Cheng Q, Sun X, Kang Q, Dai L, Zhou X, Song Z

Received 4 August 2018

Accepted for publication 27 October 2018

Published 26 November 2018 Volume 2018:14 Pages 3231—3240


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Yuping Ning

Pengfei Cao,1,2,* Jun Xing,1,* Yin Cao,3 Qi Cheng,1 Xiaojing Sun,1 Qi Kang,1 Libin Dai,1 Xianju Zhou,3 Zixiang Song1

1Psychological Centre for Adolescents and Children, The Affiliated 102nd Hospital of The Second Military Medical University of People’s Liberation Army of China, Shanghai, China; 2Department of Political Affairs, College of Politics, National Defense University of People’s Liberation Army of China, Beijing, China; 3Laboratory of Neurological Diseases, Department of Neurology, The Affiliated Changzhou No 2 People’s Hospital of Nanjing Medical University, Changzhou, China

*These authors contributed equally to this work

Objective: To explore the effect of repetitive transcranial magnetic stimulation (rTMS) combined with atomoxetine (ATX) in the treatment of attention-deficit hyperactivity disorder (ADHD).
Methods: Sixty-four patients with newly diagnosed ADHD were enrolled from January 2016 to October 2017 from Psychological Centre for Adolescents and Children at 102th Hospital of People’s Liberation Army of China. These patients were randomly assigned to three groups according to treatment method: the rTMS group, the ATX group, and the rTMS+ ATX group. Before treatment and 6 weeks after treatment, clinical symptoms and executive functions of ADHD patients were evaluated with the Swanson, Nolan, and Pelham, Version IV (SNAP-IV) Questionnaire, continuous performance test, three subtests (arithmetic, digit span, and coding) of Wechsler Intelligence Scale for Children, as well as Iowa Gambling Tasks (IGT). The effects of treatment were compared among three groups.
Results: After 6 weeks of treatment, the scores of all factors in the SNAP-IV questionnaire were lower than those before treatment in the three groups; the scores of three subtests of Wechsler Intelligence Scale for Children, continuous performance test, and IGT were also significantly higher than those before treatment. The rTMS+ ATX group had a better improvement in attention deficits and hyperactivity impulse on the SNAP-IV questionnaire compared with the other groups, and also had a higher efficacy on cold and hot executive functions such as arithmetic, forward numbers, coding, and IGT. In addition, the ATX group performed better than the rTMS group in coding and IGT.
Conclusion: rTMS, ATX, and the combination therapy are effective in improving core symptoms and executive function in patients with ADHD. The combined treatment has significant therapeutic advantages over the single treatment groups. Compared with rTMS, the drug therapy has a better improvement in coding and IGT.

Keywords: attention-deficit hyperactivity disorder, repetitive transcranial magnetic stimulation, atomoxetine, executive function

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