Trigeminal Nerve Stimulation for ADHD (TNS for ADHD)

• ClinicalTrials.gov Identifier: NCT02155608
• Recruitment Status: Completed
• First Posted: June 4, 2014
• Results First Posted: April 12, 2019
• Last Update Posted: July 2, 2019
• Sponsor: University of California, Los Angeles
• Collaborator: National Institute of Mental Health (NIMH)
• Information provided by (Responsible Party): James McGough, University of California, Los Angeles

Study Description

Brief Summary:

The purpose of this study is to develop external Trigeminal Nerve Stimulation (eTNS) as a potential nonmedication treatment for attention-deficit/hyperactivity disorder (ADHD).

Study hypothesis address potential differences over 4 weeks of active vs. sham eTNS treatment on ADHD symptoms, measures of executive function, electroencephalography (EEG) profiles, other dimensional measures of height, weight, mood, anxiety, and sleep, and side effect profiles.

Condition or disease	Intervention/treatment	Phase
Attention Deficit Hyperactivity Disorder (ADHD)	Device: Active eTNS; Device: Sham eTNS	Not Applicable

Detailed Description:

This three-year developmental study is a double-blind randomized trial of active vs. inactive sham eTNS for ADHD, with four weeks acute treatment followed by an additional one week of clinical observation and testing after treatment cessation.

The study will enroll 85-90 participants aged 8-12 years to achieve a completion target of N=36 for each study condition (total final N = 72). Participants will meet Diagnostic and Statistical Manual-5 (DSM-5) criteria for ADHD, any current presentation, as established by the Behavior Disorders Module of the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-PL) and clinical interview.

Other screening procedures include measures of ADHD symptom severity, other behavioral ratings, and cognitive assessments. Once inclusion/exclusion criteria have been reviewed and verified, participants in Phase 1A will have a pre-treatment visit to establish behavioral and cognitive baseline ratings and to obtain an EEG. Participants and parents will be instructed in the use of eTNS, and participants will begin use of the eTNS as directed during sleep each night. Participants will be randomized 1:1 to active or inactive sham eTNS. Participants, families, and most of the study team will remain blind to treatment assignment. Participants will have weekly assessments over the five-week study to assess behavioral, cognitive, and brain activation change and to monitor safety, tolerability, and compliance. Weekly ratings will be obtained from a parent, teacher, and clinician investigator. EEG will occur at baseline, end of treatment (week 4).

In Phase 1B, all participants remain blinded for one week after cessation of the intervention and return for a final visit to assess residual effects of eTNS therapy vs. sham.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 62 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Masking Description: Double-blind, sham-controlled.
• Primary Purpose: Treatment
• Official Title: Developmental Pilot Study of External Trigeminal Nerve Stimulation for ADHD
• Actual Study Start Date: April 1, 2015
• Actual Primary Completion Date: May 30, 2018
• Actual Study Completion Date: May 30, 2018

Arms and Interventions

Arm	Intervention/treatment
Experimental: Active eTNS; Following screening and determination of eligibility, participants at baseline are randomized to receive 4 weeks nightly treatment with active or sham eTNS, followed by one week ongoing blinded assessment following treatment discontinuation. Positive responders will be invited to participate in a 12-month open extension.	Device: Active eTNS; Participants will receive active trigeminal nerve stimulation (TNS) administered by the Monarch eTNS System nightly during sleep for 4 weeks, followed by one week of observation and followup while remaining blinded following treatment discontinuation. Participant deemed to be positive responders to blinded active treatment will be invited to continue open eTNS in a 12 month extension period.; Other Names: Trigeminal Nerve Stimulation; Monarch eTNS SystemTM (NeuroSigma, Inc., Los Angeles CA
Sham Comparator: Sham eTNS; Following screening and determination of eligibility, participants at baseline are randomized to receive 4 weeks nightly treatment with active or sham eTNS, followed by one week ongoing blinded assessment following treatment discontinuation. Following double-blind phase, interested participants randomized to sham have an option for a 4-week open TNS trial. Positive responders will be invited to participate in a 12-month open extension.	Device: Sham eTNS; Participants will receive sham trigeminal nerve stimulation (TNS) administered by the Monarch eTNS System nightly during sleep for 4 weeks, followed by one week of observation and followup while remaining blinded following treatment discontinuation. At the conclusion of the blinded trial, participants randomized to the sham group will be offered 4 weeks of open eTNS treatment. Participants deemed to be positive responders to open treatment will be invited to continue open nightly eTNS in a 12 month extension period.

Outcome Measures

Primary Outcome Measures :

1. ADHD-IV Rating Scale (ADHD-RS) [ Time Frame: Change over baseline and weeks 1, 2, 3, 4 and 5. ]
   A dimensional rating of ADHD symptoms, with scores ranging from 0 - 54, and higher scores indicating greater symptom severity.

Secondary Outcome Measures :

1. Clinical Global Impression - Improvement (CGI-I) [ Time Frame: Change over weeks 1, 2, 3, 4, and 5 compared with baseline. ]
   Categorical measure indicating degree improved or not improved compared with baseline for each treatment group. Minimum score = 1 (very much improved); Maximum score = 7 (very much worse). Results reflect number of participants stratified as "Improved" (CGI-I <=2) or "Not Improved" (CGI-I > 2).
2. Conners Global Index - Parent Report [ Time Frame: Change over baseline and weeks 1, 2, 3, 4, 5. ]
   Parent completed dimensional measure of ADHD symptoms, with score range from 0- 30, and higher scores indicating more severe symptoms.
3. Affective Reactivity Index (ARI) - Child [ Time Frame: Change over baseline and weeks 4 and 5. ]
   A child completed dimensional measure of emotional reactivity, with scores ranging from 0-12, and higher scores indicating greater severity.
4. Affective Reactivity Index (ARI) - Parent Report [ Time Frame: Change over baseline and weeks 4 and 5. ]
   A parent completed dimensional measure of emotional reactivity, with scores ranging from 0-12, and higher scores indicating greater severity.
5. Multidimensional Anxiety Scale for Children (MASC) - Child Report [ Time Frame: Change over baseline and weeks 4 and 5. ]
   A child completed rating of child anxiety, with scores ranging from 0-300, and higher scores indicating greater severity.
6. Multidimensional Anxiety Scale for Children (MASC) - Parent Report [ Time Frame: Change over baseline and weeks 4 and 5. ]
   A parent completed rating of child anxiety, with scores ranging from 0-300, and higher scores indicating greater severity.
7. Height [ Time Frame: Change over baseline and weeks 1, 4, and 5. ]
   A dimensional measure assessed in centimeters (cm).
8. Weight [ Time Frame: Change over baseline and weeks 1, 4, and 5. ]
   A dimensional measure assessed in kilograms (kg).
9. Systolic Blood Pressure [ Time Frame: Change over baseline and weeks 1, 4, and 5. ]
   A dimensional measure expressed in mm mercury (Hg).
10. Diastolic Blood Pressure [ Time Frame: Change over baseline and weeks 1, 4, and 5. ]
    A dimensional measure assessed in mm mercury (Hg).
11. Pulse [ Time Frame: Change over baseline and weeks weeks 1, 4, and 5. ]
    Heart rate in beats per minute (bpm).
12. Children's Depression Inventory (CDI) [ Time Frame: Change over baseline and weeks 4 and 5. ]
    A child completed self-report dimensional measure of depressive symptoms, with range of scores from 0 to 54. Higher scores reflect increasing depression. Cutoff scores < 17 to 20 are generally considered to be in the normative range. A score of 36 or higher reflects a relatively severe depression.
13. Conners Global Index - Teacher [ Time Frame: Change over baseline and weeks 1, 2, 3, 4, 5. ]
    Teacher completed dimensional measure of ADHD symptoms, with scores ranging from 0-30, and higher scores indicating more severe symptoms.

Other Outcome Measures:

1. Affective Posner Task [ Time Frame: Baseline, and Weeks 1 and 4 ]
   A laboratory measure of frustration tolerance.
2. Attention Network Task (ANT) Response Inhibition [ Time Frame: Baseline, Weeks 1 and 4 ]
   A computer-administered laboratory measure of executive function.
3. Spatial Working Memory (SWM) [ Time Frame: Baseline, Weeks 1 and 4 ]
   A computer-administered laboratory measure of executive function.
4. Electroencephalography (EEG) [ Time Frame: Baseline and Week 4 ]
   A laboratory measure of cortical activity.
5. Behavior Rating Inventory of Executive Functioning (BRIEF) [ Time Frame: Baseline, end of Weeks 4 and 5. ]
   A parent completed rating of child executive function. Comprises 5 sub scales that measure various measures of behavior and cognition. Raw scores on each measure are converted to T scores ranging from 28 to 103, with higher scores indicating greater difficulties.
6. Children's Sleep Habits Questionnaire (CSHQ) [ Time Frame: Weekly for double-blind trial. ]
   A parent completed 33-item scale to assess sleep related problems. Total scores range from 33 to 99 divided among 8 sub scales , with higher scores indicating more severe difficulties.

Eligibility Criteria

• Ages Eligible for Study: 8 Years to 12 Years (Child)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• male and female children ages 8 to 12 years with DSM-5 ADHD, any current presentation, as determined by KSADS and clinical interview
• minimum scores of 12 on both the inattentive and hyperactive/impulsive subscales of the baseline ADHD-RS
• CGI-S score at baseline ≥ 4
• no current medication with CNS effects
• parents able and willing to monitor proper use of the stimulation device and complete all required rating scales
• estimated Full Scale IQ ≥ 85 based on WASI subtests
• parent and participant able to complete rating scales and other measures in English
• able to cooperate during EEG

Exclusion Criteria:

• impaired functioning to a degree that requires immediate initiation of ADHD medication in the opinion of the parents and/or investigator
• current diagnosis of autism spectrum disorder or major depression
• history of lifetime psychosis, mania, seizure disorder or head injury with loss of consciousness
• baseline suicidality

Contacts and Locations

Locations

United States, California

UCLA Semel Institute

Los Angeles, California, United States, 90095

Sponsors and Collaborators

University of California, Los Angeles

National Institute of Mental Health (NIMH)

Investigators

• Principal Investigator: James J McGough, M.D.; University of California, Los Angeles
• Principal Investigator: Sandra K Loo, Ph.D.; University of California, Los Angeles

  Study Documents (Full-Text)

Documents provided by James McGough, University of California, Los Angeles:

Study Protocol and Statistical Analysis Plan  [PDF] May 30, 2018

Informed Consent Form  [PDF] April 28, 2015

More Information

Additional Information:

Pub Med Abstract 

Publications of Results:

McGough JJ, Sturm A, Cowen J, Tung K, Salgari GC, Leuchter AF, Cook IA, Sugar CA, Loo SK. Double-Blind, Sham-Controlled, Pilot Study of Trigeminal Nerve Stimulation for Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. 2019 Apr;58(4):403-411.e3. doi: 10.1016/j.jaac.2018.11.013. Epub 2019 Jan 28.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Loo SK, Salgari GC, Ellis A, Cowen J, Dillon A, McGough JJ. Trigeminal Nerve Stimulation for Attention-Deficit/Hyperactivity Disorder: Cognitive and Electroencephalographic Predictors of Treatment Response. J Am Acad Child Adolesc Psychiatry. 2021 Jul;60(7):856-864.e1. doi: 10.1016/j.jaac.2020.09.021. Epub 2020 Oct 15.

• Responsible Party: James McGough, Professor of Clinical Psychiatry, University of California, Los Angeles
• ClinicalTrials.gov Identifier: NCT02155608
• Other Study ID Numbers: NIMH R34MH101282; R34MH101282 ( U.S. NIH Grant/Contract )
• First Posted: June 4, 2014
• Results First Posted: April 12, 2019
• Last Update Posted: July 2, 2019
• Last Verified: June 2019

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

Keywords provided by James McGough, University of California, Los Angeles:

ADHD; neuromodulation; trigeminal nerve stimulation; cognition

Additional relevant MeSH terms:

Attention Deficit Disorder with Hyperactivity; Attention Deficit and Disruptive Behavior Disorders; Neurodevelopmental Disorders; Mental Disorders