Trigeminal Nerve Stimulation in ADHD

By AADHDI | August 6, 2021

A study by Copur & Copur (2021) has just been published, reviewing Trigeminal Nerve Stimulation (TNS) and its efficacy in ADHD (1). A Trigeminal Nerve Stimulator is the first medical device to receive FDA approval. When the supraorbital branch of the ophthalmic branch of the trigeminal nerve is stimulated, the impulse is carried into the cerebral hemispheres and brainstem at which change in excitability of neurons occurs (2). Neuroimaging studies confirm the
altered neuronal activity at the thalamus, insula, amygdala, hippocampus, and precentral gyrus after TNS (3).

According to this study ADHD medication are not effective in 20% of people with ADHD, and ADHD medications cannot be taken when their are certain conditions such as cardiovascular disease. TNS therefore provides an additional way to help patients for whom medication does not work or it can’t be taken. In 2019, TNS was the first medical device with FDA approval in children 7-12 years. The use of TNS in neuropsychiatric disorders is not limited to ADHD and includes epilepsy, depression, pain disorders, and migraine. The first study examining TNS in patients with ADHD was in 2015 (4), and found  improvements at inattention and hyperactivity symptoms. The first double-blind randomized controlled trial was conducted in 2019 with improvements noted in ADHD symptoms above controls (5).

They concluded that at this stage studies investigating how TNS works are scarce and non-comprehensive. The lack of withdrawal symptoms or drug induced emotional liability appears to be the strengths of the TNS approach while beneficial effects obtained with TNS are abruptly reversible after discontinuation similar to stimulatory drugs. Although comprehensive studies about the efficiency of TNS in ADHD are lacking, TNS appears to be a valid option
especially for treatment-refractory cases with no apparent adverse effect. Therefore, it is important for people to be aware of such recently approved treatment option for ADHD.

 

References:

  1. Mazlum, Ç., & Çöpür Sidar. (2021). Trigeminal nerve stimulation: A recently approved treatment approach in attention deficit hyperactivity disorder. The Egyptian Journal of Neurology, Psychiatry, and Neurosurgery, 57(1) doi:http://dx.doi.org/10.1186/s41983-021-00353-w
  2. Shim S-H, Yoon H-J, Bak J, Hahn S-W, Kim Y-K. Clinical and neurobiological
    factors in the management of treatment refractory attention-deficit
    hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2016;70:
    237–44. https://doi.org/10.1016/j.pnpbp.2016.04.007.
  3. Fanselow EE. Central mechanisms of cranial nerve stimulation for epilepsy.
    Surg Neurol Int. 2012;3(Suppl 4):S247–S54. https://doi.org/10.4103/2152-
    7806.103014.
  4. McGough JJ, Loo SK, Sturm A, Cowen J, Leuchter AF, Cook IA. An eightweek,
    open-trial, pilot feasibility study of trigeminal nerve stimulation in
    youth with attention-deficit/hyperactivity disorder. Brain Stimul. 2015;8(2):
    299–304. https://doi.org/10.1016/j.brs.2014.11.013.
  5. McGough JJ, Sturm A, Cowen J, Tung K, Salgari GC, Leuchter AF, et al.
    Double-blind, sham-controlled, pilot study of trigeminal nerve stimulation
    for attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc
    Psychiatry. 2019;58(4):403–11.e3.
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