Evidence map›Paper›PMID 40018690›Full record

SynthesisFrontiers in psychiatry2025

Transcranial magnetic stimulation in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis of cortical excitability and therapeutic efficacy.

Yu Han, Zi-Yu Wei, Na Zhao, Qian Zhuang, Hang Zhang, Hong-Li Fang, Yu-Feng Zang, Zi-Jian Feng

Abstract readSystematic Review
In one paragraph

Synthesis in Frontiers in psychiatry, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
  4. Review
  5. Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Yu HanTranscranial Magnetic Stimulation (TMS) Center, Deqing Hospital of Hangzhou Normal University, Zhejiang, Huzhou, China.
Zi-Yu WeiTranscranial Magnetic Stimulation (TMS) Center, Deqing Hospital of Hangzhou Normal University, Zhejiang, Huzhou, China.
Na ZhaoCentre for Cognition and Brain Disorders/Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.
Qian ZhuangCentre for Cognition and Brain Disorders/Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.
Hang ZhangCentre for Cognition and Brain Disorders/Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.
Hong-Li FangCentre for Cognition and Brain Disorders/Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.
Yu-Feng ZangTranscranial Magnetic Stimulation (TMS) Center, Deqing Hospital of Hangzhou Normal University, Zhejiang, Huzhou, China.
Zi-Jian FengTranscranial Magnetic Stimulation (TMS) Center, Deqing Hospital of Hangzhou Normal University, Zhejiang, Huzhou, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background/Objectives: Attention-deficit/hyperactivity disorder (ADHD) currently lacks a universally accepted biomarker or diagnostic test, underscoring the need for objective and effective assessment methods. Transcranial magnetic stimulation (TMS) has emerged as a promising tool for both assessing cortical excitability and providing therapeutic interventions. This study conducted two independent meta-analyses to evaluate: 1) the potential of TMS in assessing cortical excitability, and 2) its therapeutic efficacy in managing ADHD symptoms. Methods: A systematic search was conducted in EMBASE, MEDLINE, PsycINFO, ClinicalTrials, and PubMed following PRISMA guidelines. The "cortical excitability" meta-analysis included studies comparing TMS-EMG or TMS-EEG neurophysiological measures between ADHD patients and healthy controls. The "therapeutic" meta-analysis focused on randomized controlled trials (RCTs) evaluating repetitive TMS (rTMS) effects on ADHD symptoms. Standardized mean differences (SMDs) were calculated for pooled effect sizes. Results: In the "cortical excitability" meta-analysis, 17 studies were included, demonstrating significantly reduced short-interval intracortical inhibition (SICI) in ADHD compared to healthy controls (pooled SMD = 0.65, 95% CI: 0.41-0.88, P < 0.00001). No significant differences were observed for motor evoked potentials (MEP), motor thresholds (aMT/rMT), cortical silent period (cSP), ipsilateral silent period (iSP), or intracortical facilitation (ICF). The "therapeutic" meta-analysis, encompassing 8 samples from 7 studies, demonstrated that rTMS significantly improved ADHD symptoms compared to control conditions (pooled SMD = 0.45, 95% CI: 0.19-0.70, P = 0.0006). Conclusions: This study highlights the potential of TMS as both a diagnostic and therapeutic tool in ADHD. Reduced SICI appears to be a key neurophysiological marker of ADHD, reflecting cortical GABAergic dysfunction. Additionally, rTMS shows promise in alleviating ADHD symptoms, though further studies are needed to confirm long-term therapeutic benefits and optimize stimulation protocols. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024507867.

Indexed as

ADHDcortical excitabilitymeta-analysistherapeutic efficacyTMS

Identifiers

PMID40018690
PMCPMC11865255

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.