Development and clinical evaluation of personalized, functional MRI-guided, accelerated transcranial magnet stimulation for adult attention-deficit/hyperactivity disorder

• Applicant: Dr. Benjamin Selaskowski
• Subject Area: Biological Psychiatry ; Clinical Psychiatry, Psychotherapy, Child and Adolescent Psychiatry
• Term: since 2025
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 565593130

Transcranial magnetic stimulation (TMS) is a non-invasive procedure that uses magnetic fields for the stimulation of neurons in the brain to treat depression and other disorders. Accelerated TMS treatment (multiple treatments per day) with stimulation target regions calculated on the basis of individual functional MRI scans has recently achieved impressive results in patients with treatment-resistant depression. The development of a similar personalized protocol for use in heterogeneous adult attention-deficit hyperactivity disorder (ADHD) appears promising. However, studies of individualized, fMRI-based, accelerated TMS have not yet been conducted in the field of ADHD. In general, the few previous attempts to treat ADHD in adults with TMS do not allow reliable conclusions on their efficacy due to substantial methodological weaknesses. The initial exploratory findings of these studies indicate potential, but are limited by relatively small sample sizes, lack of adequate blinding or sham conditions, and no consistency in stimulation targets, including right, left, or bilateral dlPFC, vlPFC, and dmPFC. Since none of the previous studies used brain imaging, state-of-the-art methods such as the selection of personalized targets and subsequent neuro-navigated stimulation could not be applied. Here, the target region can be localized using previously recorded individual MRI scans, which then form the basis for live coil navigation to stimulate the intended target with high precision. Similarly, the consideration of individual anatomical differences, such as the scalp-to-cortex distance, for determining the stimulation intensity could not be taken into account. The project presented here therefore has two main objectives. First, a feasible target region for TMS treatment of ADHD will be identified. The existing neuroimaging literature provides evidence of changes in resting-state functional connectivity of hubs of different attention networks. In the first stage of the project, a TMS protocol will be developed based on an existing fMRI dataset to investigate TMS accessible cortical target regions for their functional connectivity with corresponding networks. After determining an optimal target region at group level, the specific target site within this region is determined based on individual fMRI. The second objective of this project is to conduct a methodologically rigorous double-blind, randomized, sham-controlled study to evaluate the developed protocol. Since the heterogeneity of ADHD is also reflected in widely used symptom measurement instruments, data on the course of treatment will be collected in a multidimensional manner. This includes, among other instruments, a virtual reality paradigm for measuring ADHD symptoms, which was co-developed by the applicant and has since been validated in several studies, as well as smartphone usage data.

• DFG Programme: Research Grants