经颅磁刺激对治疗儿童注意力缺陷多动障碍的研究进展

摘要儿童注意力缺陷多动障碍（attentiondeficithyperactivitydisorder,ADHD）是一种常见的神经发育障碍性疾病，其病因复杂，涉及遗传、神经递质异常、脑结构异常、环境因素及睡眠障碍等多方面因素。目前，ADHD的常用治疗方法包括药物治疗、行为矫正及针灸推拿等，但药物治疗可能导致多种不良反应，行为矫正疗法的效果则因个体差异而异。经颅磁刺激（TranscranialMagneticStimulation,TMS）作为一种非侵入性神经调控技术，已被广泛应用于多种神经精神疾病的治疗，包括ADHD。然而，关于TMS治疗ADHD的具体实施方案，如刺激强度、频率、部位及持续时间等，目前尚无统一标准，且TMS联合其他治疗方案的有效性仍存在争议。本文综述了TMS治疗ADHD的研究现状，重点探讨了TMS的分类、安全性、指南以及在ADHD中的评估与治疗应用。TMS根据刺激脉冲的数量和模式可分为单脉冲TMS（single-pulseTMS，sTMS）、成对脉冲TMS（paired-pulseTMS，ppTMS）、重复脉冲TMS（RepeatedTMS，rTMS）及Theta波爆发刺激（Thetaburststimulation，TBS）。研究表明，TMS在ADHD的评估中可联合功能性近红外光谱成像（functionalnear-infraredspectroscopy,fNIRS）、脑电图（electroencephalogram，EEG）及磁共振波谱分析（MagneticResonanceSpectroscopy，MRS）等技术，为深入理解TMS的神经机制提供了新的视角。在治疗应用方面，TMS在改善ADHD儿童的注意力缺陷、过度活动、认知功能及社会能力等方面显示出显著的潜力。此外，TMS联合药物治疗、认知行为训练、感觉统合训练及针灸治疗等联合治疗方案也为ADHD的治疗提供了新的思路和方法。尽管如此，目前的研究仍存在诸多局限性，如样本量较小、缺乏随机对照试验（Randomizedcontrolledtrial，RCT）、缺乏客观的生物标志物或神经影像学指标以及缺乏多中心试验等。未来的研究应重点关注最佳TMS参数的确定、对ADHD患儿临床症状的具体改善以及抗炎与氧化应激调节机制的探索。通过这些研究，有望为ADHD的治疗提供更科学、更有效的策略，为临床应用提供更坚实的理论基础。关键词：注意力缺陷多动障碍，经颅磁刺激，儿童，神经调控ABSTRACTSAttentiondeficithyperactivitydisorder(ADHD)isacommonneurodevelopmentaldisorderwithcomplexetiologyinvolvinggenetic,neurotransmitterabnormalities,brainstructuralanomalies,environmentalfactors,andsleepdisorders.CurrenttreatmentsforADHDincludepharmacotherapy,behavioraltherapy,andacupuncture,butpharmacotherapymaycausevariousadversereactions,andtheefficacyofbehavioraltherapyvariesamongindividuals.Transcranialmagneticstimulation(TMS),anon-invasiveneuromodulatorytechnique,hasbeenwidelyappliedinthetreatmentofvariousneuropsychiatricdisorders,includingADHD.However,thereisnounifiedstandardforthespecificimplementationplanofTMStreatmentforADHD,suchasstimulationintensity,frequency,location,andduration,andtheeffectivenessofTMScombinedwithothertreatmentregimensremainscontroversial.ThisreviewsummarizesthecurrentresearchstatusofTMStreatmentforADHD,focusingontheclassification,safety,guidelines,andassessmentandtherapeuticapplicationsofTMSinADHD.TMScanbecategorizedintosingle-pulseTMS(sTMS),paired-pulseTMS(ppTMS),repetitiveTMS(rTMS),andtheta-burststimulation(TBS)basedonthenumberandpatternofstimulationpulses.StudieshaveshownthatTMScanbecombinedwithfunctionalnear-infraredspectroscopy(fNIRS),electroencephalogram(EEG),andmagneticresonancespectroscopy(MRS)toprovidenewinsightsintotheneuralmechanismsofTMSintheassessmentofADHD.Intermsoftherapeuticapplications,TMShasshownsignificantpotentialinimprovingattentiondeficits,hyperactivity,cognitivefunctions,andsocialabilitiesinchildrenwithADHD.Moreover,combinedtreatmentregimensofTMSwithpharmacotherapy,cognitive-behavioraltraining,sensoryintegrationtraining,andacupuncturealsooffernewideasandmethodsforADHDtreatment.Nevertheless,currentresearchstillhasmanylimitations,suchassmallsamplesizes,lackofrandomizedcontrolledtrials(RCTs),absenceofobjectivebiomarkersorneuroimagingindicators,andlackofmulticentertrials.FutureresearchshouldfocusondeterminingtheoptimalTMSparameters,specificimprovementsinclinicalsymptomsofADHDpatients,andexplorationofanti-inflammatoryandoxidativestressregulationmechanisms.Throughthesestudies,itisexpectedtoprovidemorescientificandeffectivestrategiesforADHDtreatmentandamoresolidtheoreticalbasisforclinicalapplications.Keywords：AttentionDeficitHyperactivityDisorder，TranscranialMagneticStimulation，Children，Neuroregulation1引言1.1儿童注意力缺陷多动障碍的危害及流行病学ADHD是一种较常见的儿童行为障碍性疾病，儿童ADHD的病因可能涉及遗传因素、神经递质异常、脑结构异常、环境因素或睡眠障碍等多方面因素，该疾病的主要临床表现为偏离正常发育水平的注意力不集中、冲动和活动过度行为,而2018年我国学龄儿童ADHD的患病率为6.3%ADDINZOTERO_ITEMCSL_CITATION{"citationID":"njtnfR1d","properties":{"formattedCitation":"\\super[1]\\nosupersub{}","plainCitation":"[1]","noteIndex":0},"citationItems":[{"id":371,"uris":["/users/local/bZLIS8iD/items/MQKSTX4F"],"itemData":{"id":371,"type":"article-journal","abstract":"Updatingtheworldwideprevalenceestimatesofattention-deficithyperactivitydisorder(ADHD)hassignificantapplicationsforthefurtherstudyofADHD.However,previousreviewsincludedfewsamplesofChinesechildrenandadolescents.ToconductasystematicreviewofADHDprevalenceinMainlandChina,HongKong,andTaiwantodeterminethepossiblecausesofthevariedestimatesinChinesesamplesandtoofferareferenceforcomputingtheworldwidepooledprevalence.WesearchedforPubMed,Embase,PsycINFO,WebofScience,ChinaNationalKnowledgeInfrastructure,VIP,WANFANGDATA,andChinaSciencePeriodicalDatabasedatabaseswithtimeandlanguagerestrictions.Atotalof67studiescovering642,266Chinesechildrenandadolescentswereincluded.TheprevalenceestimatesofADHDinMainlandChina,HongKong,andTaiwanwere6.5%,6.4%,and4.2%,respectively,withapooledestimateof6.3%.Multivariatemeta-regressionanalysesindicatedthattheyearofdatacollection,age,andfamilysocioeconomicstatusoftheparticipantsweresignificantlyassociatedwiththeprevalenceestimates.OurfindingssuggestthatgeographiclocationplaysalimitedroleinthelargevariabilityofADHDprevalenceestimates.Instead,thevariabilitymaybeexplainedprimarilybytheyearsofdatacollection,andchildren'ssocioeconomicbackgrounds,andmethodologicalcharacteristicsofstudies.","container-title":"ScientificReports","DOI":"10.1038/s41598-018-29488-2","ISSN":"2045-2322","issue":"1","journalAbbreviation":"SciRep","language":"en","note":"PMID:30115972\nPMCID:PMC6095841\nTLDR:ItissuggestedthatgeographiclocationplaysalimitedroleinthelargevariabilityofADHDprevalenceestimates,andthevariabilitymaybeexplainedprimarilybytheyearsofdatacollection,andchildren’ssocioeconomicbackgrounds,andmethodologicalcharacteristicsofstudies.","page":"11169","source":"PubMed","title":"ThePrevalenceofAttentionDeficit/HyperactivityDisorderamongChineseChildrenandAdolescents","volume":"8","author":[{"family":"Liu","given":"Anni"},{"family":"Xu","given":"Yunwen"},{"family":"Yan","given":"Qiong"},{"family":"Tong","given":"Lian"}],"issued":{"date-parts":[["2018",8,16]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[1]。1.2常规ADHD治疗方法的局限性ADHD常用治疗方法包括药物治疗、行为矫正和针灸推拿等其他治疗方法，药物治疗主要采用哌甲酯和托莫西汀，然而药物治疗可能导致情绪波动、睡眠困难、食欲下降、胃痛、皮肤抓挠/重复行为、退缩行为和体重下降等不良反应,给治疗造成困难ADDINZOTERO_ITEMCSL_CITATION{"citationID":"bNxbpJ8G","properties":{"formattedCitation":"\\super[2]\\nosupersub{}","plainCitation":"[2]","noteIndex":0},"citationItems":[{"id":395,"uris":["/users/local/bZLIS8iD/items/M7C7AUJS"],"itemData":{"id":395,"type":"article-journal","abstract":"OBJECTIVES:Tocharacterizeandcomparethetypeandfrequencyofarangeofcommonanduncommonadverseeffects(AEs)associatedwithα-2adrenergicagonist(A2A)andstimulanttreatmentofattention-deficit/hyperactivitydisorderatpreschool-ageaswellastoevaluatetheimpactofageoncommonAEs.\nSTUDYDESIGN:Thiswasaretrospectiveelectronicmedicalrecordreviewofchildren<72

monthsofage(n

=

497)evaluatedatoutpatientdevelopmental-behavioralpediatricpracticesat7USacademicmedicalcenterswithintheDevelopmental-BehavioralPediatricsResearchNetwork.DataonAEswereabstractedforchildrenwhohadtreatmentinitiatedbyadevelopmental-behavioralpediatricianwithanA2AorstimulantmedicationbetweenJanuary2013andJuly2017;follow-upwascompletebyFebruary

2019.\nRESULTS:A2AandstimulantshaddistinctiveAEprofiles.A2Acomparedwithstimulantshadagreaterproportionwithdaytimesleepinessandheadaches;stimulantshadsignificantlygreaterproportionsformostotherAE,includingmoodiness/irritability,difficultywithsleep,appetitesuppression,stomachaches,skinpicking/repetitivebehaviors,withdrawnbehavior,andweightloss.Youngeragewasassociatedwithdisruptivebehavioranddifficultywithsleep.\nCONCLUSIONS:StimulantshadagreaterrateofmostAEscomparedwithA2A.AEprofiles,togetherwithefficacy,shouldinformclinicaldecision-making.ProspectiverandomizedclinicaltrialsareneededtofullycompareefficacyandAEprofilesofA2Aandstimulants.","container-title":"TheJournalofPediatrics","DOI":"10.1016/j.jpeds.2023.01.004","ISSN":"1097-6833","journalAbbreviation":"JPediatr","language":"en","note":"PMID:36649794","page":"113325","source":"PubMed","title":"AdverseEffectsofα-2AdrenergicAgonistsandStimulantsinPreschool-ageAttention-deficit/HyperactivityDisorder:ADevelopmental-BehavioralPediatricsResearchNetworkStudy","title-short":"AdverseEffectsofα-2AdrenergicAgonistsandStimulantsinPreschool-ageAttention-deficit/HyperactivityDisorder","volume":"257","author":[{"family":"Loe","given":"IreneM."},{"family":"Blum","given":"NathanJ."},{"family":"Shults","given":"Justine"},{"family":"Barbaresi","given":"William"},{"family":"Bax","given":"Ami"},{"family":"Cacia","given":"Jaclyn"},{"family":"Deavenport-Saman","given":"Alexis"},{"family":"Friedman","given":"Sandra"},{"family":"LaRosa","given":"Angela"},{"family":"Mittal","given":"Shruti"},{"family":"Vanderbilt","given":"Douglas"},{"family":"Harstad","given":"Elizabeth"}],"issued":{"date-parts":[["2023",6]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[2]，行为矫正疗法的效果可能因个体差异而异，且在某些情况下，家长和教师的参与度和一致性可能会影响治疗效果ADDINZOTERO_ITEMCSL_CITATION{"citationID":"YgF8KNrN","properties":{"formattedCitation":"\\super[3]\\nosupersub{}","plainCitation":"[3]","noteIndex":0},"citationItems":[{"id":398,"uris":["/users/local/bZLIS8iD/items/AQA5LSZH"],"itemData":{"id":398,"type":"article-journal","abstract":"Attention-deficit/hyperactivitydisorder(ADHD)isaprevalent,chronic,andimpairingmentalhealthdisorderofchildhood.Decadesofempiricalresearchhasestablishedastrongevidence-basedinterventionarmamentariumforADHD;however,limitationsexistinregardstoefficacyandeffectivenessoftheseinterventions.Weprovideanoverviewofselectevidence-basedinterventionsforchildrenandadolescents,highlightingpotentialapproachestofurtherimprovingtheefficacyandeffectivenessoftheseinterventions.Weconcludewithbroaderrecommendationsforinterventions,includingconsiderationstomoderatorsandunder-exploredinterventiontargetareasaswellasavenuestoimproveaccessandavailabilityofevidence-basedinterventionsthroughleveragingunderutilizedworkforcesandleveragingtechnology.","container-title":"TranslationalPsychiatry","DOI":"10.1038/s41398-024-02890-3","ISSN":"2158-3188","issue":"1","journalAbbreviation":"TranslPsychiatry","language":"en","note":"PMID:38851829\nPMCID:PMC11162428","page":"244","source":"PubMed","title":"Improvingtheefficacyandeffectivenessofevidence-basedpsychosocialinterventionsforattention-deficit/hyperactivitydisorder(ADHD)inchildrenandadolescents","volume":"14","author":[{"family":"Chacko","given":"Anil"},{"family":"Merrill","given":"BrittanyM."},{"family":"Kofler","given":"MichaelJ."},{"family":"Fabiano","given":"GregoryA."}],"issued":{"date-parts":[["2024",6,8]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[3]。1.3研究背景与目的TMS技术是一种利用TMS刺激器通过切向放置在头部的线圈传递短时电流，产生垂直于该线圈的磁场，从而穿透大脑周围的组织，并在目标组织中产生感应电流刺激皮质神经轴突去极化的无创神经调控技术ADDINZOTERO_ITEMCSL_CITATION{"citationID":"77aWePsB","properties":{"formattedCitation":"\\super[4]\\nosupersub{}","plainCitation":"[4]","noteIndex":0},"citationItems":[{"id":380,"uris":["/users/local/bZLIS8iD/items/8BYTWGA9"],"itemData":{"id":380,"type":"article-journal","abstract":"Transcranial(electro)magneticstimulation(TMS)iscurrentlythemethodofchoicetonon-invasivelyinduceneuralactivityinthehumanbrain.Asingletranscranialstimulusinducesatime-varyingelectricfieldinthebrainthatmayevokeactionpotentialsincorticalneurons.Thespatialrelationshipbetweenthelocallyinducedelectricfieldandthestimulatedneuronsdeterminesaxonaldepolarization.Theinducedelectricfieldisinfluencedbytheconductivepropertiesofthetissuecompartmentsandisstrongestinthesuperficialpartsofthetargetedcorticalgyriandunderlyingwhitematter.TMSlikelytargetsaxonsofbothexcitatoryandinhibitoryneurons.ThepropensityofindividualaxonstofireanactionpotentialinresponsetoTMSdependsontheirgeometry,myelinationandspatialrelationtotheimposedelectricfieldandthephysiologicalstateoftheneuron.Thelatterisdeterminedbyitstranssynapticdendriticandsomaticinputs,intrinsicmembranepotentialandfiringrate.ModelingworksuggeststhattheprimarytargetofTMSisaxonalterminalsinthecrowntopandlipregionsofcorticalgyri.Theinducedelectricfieldmayadditionallyexcitebendsofmyelinatedaxonsinthejuxtacorticalwhitematterbelowthegyralcrown.Neuronalexcitationspreadsortho-andantidromicallyalongthestimulatedaxonsandcausessecondaryexcitationofconnectedneuronalpopulationswithinlocalintracorticalmicrocircuitsinthetargetarea.Axonalandtranssynapticspreadofexcitationalsooccursalongcortico-corticalandcortico-subcorticalconnections,impactingonneuronalactivityinthetargetednetwork.Bothlocalandremoteneuralexcitationdependcriticallyonthefunctionalstateofthestimulatedtargetareaandnetwork.TMSalsocausessubstantialdirectco-stimulationoftheperipheralnervoussystem.Peripheralco-excitationpropagatescentrallyinauditoryandsomatosensorynetworks,butalsoproducesbrainresponsesinothernetworkssubservingmultisensoryintegration,orientingorarousal.ThecomplexityoftheresponsetoTMSwarrantscautiousinterpretationofitsphysiologicalandbehaviouralconsequences,andadeeperunderstandingofthemechanisticunderpinningsofTMSwillbecriticalforadvancingitasascientificandtherapeutictool.","container-title":"ClinicalNeurophysiology:OfficialJournaloftheInternationalFederationofClinicalNeurophysiology","DOI":"10.1016/j.clinph.2022.04.022","ISSN":"1872-8952","journalAbbreviation":"ClinNeurophysiol","language":"en","note":"PMID:35738037\nPMCID:PMC9753778\nTLDR:ThecomplexityoftheresponsetoTMSwarrantscautiousinterpretationofitsphysiologicalandbehaviouralconsequences,andadeeperunderstandingofthemechanisticunderpinningsofTMSwillbecriticalforadvancingitasascientificandtherapeutictool.","page":"59-97","source":"PubMed","title":"Transcranialmagneticstimulationofthebrain:Whatisstimulated?-Aconsensusandcriticalpositionpaper","title-short":"Transcranialmagneticstimulationofthebrain","volume":"140","author":[{"family":"Siebner","given":"HartwigR."},{"family":"Funke","given":"Klaus"},{"family":"Aberra","given":"AmanS."},{"family":"Antal","given":"Andrea"},{"family":"Bestmann","given":"Sven"},{"family":"Chen","given":"Robert"},{"family":"Classen","given":"Joseph"},{"family":"Davare","given":"Marco"},{"family":"DiLazzaro","given":"Vincenzo"},{"family":"Fox","given":"PeterT."},{"family":"Hallett","given":"Mark"},{"family":"Karabanov","given":"AnkeN."},{"family":"Kesselheim","given":"Janine"},{"family":"Beck","given":"MikkelM."},{"family":"Koch","given":"Giacomo"},{"family":"Liebetanz","given":"David"},{"family":"Meunier","given":"Sabine"},{"family":"Miniussi","given":"Carlo"},{"family":"Paulus","given":"Walter"},{"family":"Peterchev","given":"AngelV."},{"family":"Popa","given":"Traian"},{"family":"Ridding","given":"MichaelC."},{"family":"Thielscher","given":"Axel"},{"family":"Ziemann","given":"Ulf"},{"family":"Rothwell","given":"JohnC."},{"family":"Ugawa","given":"Yoshikazu"}],"issued":{"date-parts":[["2022",8]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[4]。TMS不仅可以联合脑电图用于评估ADHD及其严重程度ADDINZOTERO_ITEMCSL_CITATION{"citationID":"ExtBLjbB","properties":{"formattedCitation":"\\super[5]\\nosupersub{}","plainCitation":"[5]","noteIndex":0},"citationItems":[{"id":386,"uris":["/users/local/bZLIS8iD/items/XJ7PSAYT"],"itemData":{"id":386,"type":"article-journal","abstract":"Transcranial(electro)magneticstimulation(TMS)iscurrentlythemethodofchoicetonon-invasivelyinduceneuralactivityinthehumanbrain.Asingletranscranialstimulusinducesatime-varyingelectricfieldinthebrainthatmayevokeactionpotentialsincorticalneurons.Thespatialrelationshipbetweenthelocallyinducedelectricfieldandthestimulatedneuronsdeterminesaxonaldepolarization.Theinducedelectricfieldisinfluencedbytheconductivepropertiesofthetissuecompartmentsandisstrongestinthesuperficialpartsofthetargetedcorticalgyriandunderlyingwhitematter.TMSlikelytargetsaxonsofbothexcitatoryandinhibitoryneurons.ThepropensityofindividualaxonstofireanactionpotentialinresponsetoTMSdependsontheirgeometry,myelinationandspatialrelationtotheimposedelectricfieldandthephysiologicalstateoftheneuron.Thelatterisdeterminedbyitstranssynapticdendriticandsomaticinputs,intrinsicmembranepotentialandfiringrate.ModelingworksuggeststhattheprimarytargetofTMSisaxonalterminalsinthecrowntopandlipregionsofcorticalgyri.Theinducedelectricfieldmayadditionallyexcitebendsofmyelinatedaxonsinthejuxtacorticalwhitematterbelowthegyralcrown.Neuronalexcitationspreadsortho-andantidromicallyalongthestimulatedaxonsandcausessecondaryexcitationofconnectedneuronalpopulationswithinlocalintracorticalmicrocircuitsinthetargetarea.Axonalandtranssynapticspreadofexcitationalsooccursalongcortico-corticalandcortico-subcorticalconnections,impactingonneuronalactivityinthetargetednetwork.Bothlocalandremoteneuralexcitationdependcriticallyonthefunctionalstateofthestimulatedtargetareaandnetwork.TMSalsocausessubstantialdirectco-stimulationoftheperipheralnervoussystem.Peripheralco-excitationpropagatescentrallyinauditoryandsomatosensorynetworks,butalsoproducesbrainresponsesinothernetworkssubservingmultisensoryintegration,orientingorarousal.ThecomplexityoftheresponsetoTMSwarrantscautiousinterpretationofitsphysiologicalandbehaviouralconsequences,andadeeperunderstandingofthemechanisticunderpinningsofTMSwillbecriticalforadvancingitasascientificandtherapeutictool.","container-title":"ClinicalNeurophysiology:OfficialJournaloftheInternationalFederationofClinicalNeurophysiology","DOI":"10.1016/j.clinph.2022.04.022","ISSN":"1872-8952","journalAbbreviation":"ClinNeurophysiol","language":"en","note":"PMID:35738037\nPMCID:PMC9753778\nTLDR:ThecomplexityoftheresponsetoTMSwarrantscautiousinterpretationofitsphysiologicalandbehaviouralconsequences,andadeeperunderstandingofthemechanisticunderpinningsofTMSwillbecriticalforadvancingitasascientificandtherapeutictool.","page":"59-97","source":"PubMed","title":"Transcranialmagneticstimulationofthebrain:Whatisstimulated?-Aconsensusandcriticalpositionpaper","title-short":"Transcranialmagneticstimulationofthebrain","volume":"140","author":[{"family":"Siebner","given":"HartwigR."},{"family":"Funke","given":"Klaus"},{"family":"Aberra","given":"AmanS."},{"family":"Antal","given":"Andrea"},{"family":"Bestmann","given":"Sven"},{"family":"Chen","given":"Robert"},{"family":"Classen","given":"Joseph"},{"family":"Davare","given":"Marco"},{"family":"DiLazzaro","given":"Vincenzo"},{"family":"Fox","given":"PeterT."},{"family":"Hallett","given":"Mark"},{"family":"Karabanov","given":"AnkeN."},{"family":"Kesselheim","given":"Janine"},{"family":"Beck","given":"MikkelM."},{"family":"Koch","given":"Giacomo"},{"family":"Liebetanz","given":"David"},{"family":"Meunier","given":"Sabine"},{"family":"Miniussi","given":"Carlo"},{"family":"Paulus","given":"Walter"},{"family":"Peterchev","given":"AngelV."},{"family":"Popa","given":"Traian"},{"family":"Ridding","given":"MichaelC."},{"family":"Thielscher","given":"Axel"},{"family":"Ziemann","given":"Ulf"},{"family":"Rothwell","given":"JohnC."},{"family":"Ugawa","given":"Yoshikazu"}],"issued":{"date-parts":[["2022",8]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[5]，同时TMS作为一种非侵入性、耐受性良好的治疗方法。目前已被用于多种神经精神疾病的治疗，其中包括ADHDADDINZOTERO_ITEMCSL_CITATION{"citationID":"KKncWgAC","properties":{"formattedCitation":"\\super[6]\\nosupersub{}","plainCitation":"[6]","noteIndex":0},"citationItems":[{"id":390,"uris":["/users/local/bZLIS8iD/items/P3F6CECH"],"itemData":{"id":390,"type":"article-journal","container-title":"TheprimarycarecompanionforCNSdisorders","DOI":"10.4088/PCC.20br02602","ISSN":"2155-7780","issue":"3","journalAbbreviation":"PrimCareCompanionCNSDisord","language":"en","note":"PMID:34043889","page":"20br02602","source":"PubMed","title":"TranscranialMagneticStimulationforAdolescentsWithADHD","volume":"23","author":[{"family":"Patel","given":"RikinKumar"},{"family":"Saeed","given":"Hina"},{"family":"Mekala","given":"HemaMadhuri"},{"family":"Lippmann","given":"Steven"}],"issued":{"date-parts":[["2021",5,27]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[6]。虽然临床试验证明TMS是治疗ADHD的有效手段之一，但是TMS治疗ADHD的具体实施方案，例如频率、强度、持续时间和刺激部位等存在差异。因此，笔者将对TMS在治疗ADHD中的评估和治疗应用以及作用机制的研究现状进行综述，希望为之后TMS治疗ADHD方面的研究和应用提供新的思路和参考。2研究方法2.1文献检索策略数据库选择：

系统检索PubMed、WebofScience、维普数据库、万方数据库和CNKI数据库，覆盖2009-2024年间的中英文文献。关键词组合

中文检索式：

("经颅磁刺激"OR"TMS")AND("儿童注意力缺陷多动障碍"OR"儿童ADHD")

英文检索式("TranscranialMagneticStimulation"[Mesh]OR"TMS")AND("AttentionDeficitHyperactivityDisorderinChildren"[Mesh]OR"ChildhoodADHD")筛选标准研究类型：队列研究、临床随机对照试验（RCT）、动物实验及机制研究研究对象：明确诊断为注意力缺陷多动障碍且年龄在2-12岁的患者干预措施：采用经颅磁刺激技术（TMS/rTMS/TBS）排除：个案报告、会议摘要、非同行评议文献2.2纳入与排除标准纳入标准：文献发表年限：2009年1月-2024年8月研究对象：明确诊断为注意力缺陷多动障碍且年龄在2-12岁的患者干预措施：以TMS（包括sTMS、ppTMS、rTMS、TBS等）发表语言：涵盖中英文文献排除标准：研究对象不符：研究对象为成人ADHD患者、未明确诊断为ADHD的儿童干预措施不符：未使用TMS技术进行治疗，使用TMS但刺激参数（如频率、强度、部位、持续时间等）不明确，无法进行有效分析的研究。研究设计缺陷：样本量过小，或无对照组、随机方法不明确、未采用盲法等的研究。数据不完整：缺乏关键结局指标数据，无法对TMS治疗效果进行评估的研究；数据存在明显错误、矛盾或缺失，难以进行有效分析和综合评价的研究。文献类型：排除个案报告、会议摘要、综述性文章、评论文章等。3TMS概述3.1TMS分类TMS根据刺激脉冲的数量和模式可以分为以下几类：3.1.1单脉冲TMS（sTMS）sTMS主要用于电生理检查和研究。sTMS向特定脑区发放单个脉冲，脉冲之间的时间间隔在1秒以上。单脉冲TMS常应用于初级运动皮层，以激活对侧手部肌肉，该过程可以通过肌电图（EMG）记录为运动诱发电位（MEPs）ADDINZOTERO_ITEMCSL_CITATION{"citationID":"p2mpoWwt","properties":{"formattedCitation":"\\super[7]\\nosupersub{}","plainCitation":"[7]","noteIndex":0},"citationItems":[{"id":402,"uris":["/users/local/bZLIS8iD/items/A5EC2SSW"],"itemData":{"id":402,"type":"article-journal","abstract":"Transcranialmagneticstimulation(TMS)isaneurophysiologictechniquetononinvasivelyinduceacontrolledcurrentpulseinaprespecifiedcorticaltarget.Thiscanbeusedtotransientlydisruptthefunctionofthetargetedcorticalregionandexplorecausalrelationstobehavior,assesscorticalreactivity,andmapoutfunctionallyrelevantbrainregions,forexampleduringpresurgicalassessments.Particularlywhenappliedrepetitively,TMScanmodifycorticalexcitabilityandtheeffectscanpropagatetrans-synapticallytointerconnectedcortical,subcortical,andspinalcordregions.Assuch,TMScanbeusedtoassessthefunctionalintegrityofneuralcircuitsandtomodulatebrainactivitywithpotentialtherapeuticintent.","container-title":"Neurology.ClinicalPractice","DOI":"10.1212/01.CPJ.0000436213.11132.8e","ISSN":"2163-0402","issue":"6","journalAbbreviation":"NeurolClinPract","language":"en","note":"PMID:24353923\nPMCID:PMC3863979\nTLDR:Transcranialmagneticstimulationisaneurophysiologictechniquetononinvasivelyinduceacontrolledcurrentpulseinaprespecifiedcorticaltargettoassessthefunctionalintegrityofneuralcircuitsandtomodulatebrainactivitywithpotentialtherapeuticintent.","page":"519-526","source":"PubMed","title":"Transcranialmagneticstimulationinneurology:Areviewofestablishedandprospectiveapplications","title-short":"Transcranialmagneticstimulationinneurology","volume":"3","author":[{"family":"Eldaief","given":"MarkC."},{"family":"Press","given":"DanielZ."},{"family":"Pascual-Leone","given":"Alvaro"}],"issued":{"date-parts":[["2013",12]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[7]。这些MEPs提供了可量化的属性，如激活的运动阈值、信号幅度和潜伏期，这些属性可以与皮质和皮质脊髓兴奋性相关联。3.1.2成对脉冲TMS（ppTMS）ppTMS是发放两个成对的脉冲，脉冲的强度可以相同或不同，间隔1-200毫秒。具体来说，短间隔的成对脉冲TMS（如1-5毫秒）可以引发皮层内的抑制（称为皮层内抑制，ICI），而较长间隔（如8-30毫秒）则可以引发皮层内的促进（称为皮层内促进，ICF），长间隔成对脉冲TMS（Long-intervalintracorticalinhibition,LICI）间隔时间大约为50-200毫秒ADDINZOTERO_ITEMCSL_CITATION{"citationID":"vvhBNYBx","properties":{"formattedCitation":"\\super[8]\\nosupersub{}","plainCitation":"[8]","noteIndex":0},"citationItems":[{"id":406,"uris":["/users/local/bZLIS8iD/items/GE34C6XV"],"itemData":{"id":406,"type":"article-journal","abstract":"Transcranialmagneticstimulation(TMS)causesrepetitivespinalmotoneurondischarges(repMNDs),buttheeffectsofshort-intervalintracorticalinhibition(SICI)andintracorticalfacilitation(ICF)onrepMNDsremainunknown.Triplestimulationtechnique(TST)andtheextendedTST-protocolsthatincludeafourthandfifthstimulation,theQuadruple(QuadS)andQuintuple(QuintS)stimulation,respectively,offerapreciseestimateofcorticalandspinalmotorneurondischarges,includingrepMNDs.TheobjectiveofourstudywastoexploretheeffectsofSICIandICFonrepMNDs.Weexploredconventionalpaired-pulseTMSprotocolsofSICIandICFwiththeTMS,TST,theQuadS,andtheQuintSprotocols,inarandomizedstudydesignin20healthyvolunteers.WefoundsignificantlylessrepMNDsintheSICIparadigmcomparedwithasingle-pulseTMS(SP-TMS).NosignificantdifferencewasobservedintheICFparadigm.Therewasasignificantinter-andintrasubjectvariabilityinbothSICIandICF.WedemonstrateasignificantreductionofrepMNDsinSICI,whichmayresultfromthesuppressionoflaterI-wavesandmediatetheinhibitionofmotor-evokedpotential(MEP).ThereisnoincreaseinrepMNDsinICFsuggestinganothermechanismunderlyingfacilitation.ThisstudyprovidestheproofthatareductionofrepMNDsmediatestheinhibitionseeninSICI.NEW&NOTEWORTHYSignificantreductionofrepetitivemotorneurondischarges(repMNDs)inshort-intervalintracorticalinhibition(SICI)mayresultfromthesuppressionoflaterI-wavesandmediatetheinhibitionofmotor-evokedpotential(MEP).ThereisnochangeinthenumberofrepMNDsinintracorticalfacilitation(ICF).TherewasasignificantvariabilityinSICIandICFinhealthysubjects.","container-title":"JournalofNeur