ArticleNeuroImage. Clinical2026
Toward precision neuromodulation in ADHD: rTMS-evoked excitability as a biomarker and ccPAS as an alternative protocol.
Article in NeuroImage. Clinical, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is associated with cognitive and emotional-motivational dysregulation and with right prefrontal cortex (rPFC) dysfunction. While repetitive transcranial magnetic stimulation (rTMS) has shown promise in alleviating ADHD symptoms, treatment outcomes are not consistent or robust. This study was designed to initiate the prospective validation process of a recently suggested electrophysiological biomarker for clinical response to high-frequency rTMS (HF-rTMS) in adults with ADHD. For biomarker non-compatible patients, the study explored the safety and efficacy of a novel treatment protocol using cortico-cortical Paired Associative Stimulation (ccPAS) as an alternative stimulation approach. Fifty-eight TMS-naive adults diagnosed with ADHD underwent biomarker screening to characterize the clinical profile of biomarker-compatible and non-compatible participants. Thereafter, a subgroup of biomarker-compatible participants (n = 15) underwent treatments with HF-rTMS (15 sessions over 3 weeks), while non-compatible participants were randomized to one of two ccPAS protocols with different order of hemispheric stimulation (left-to-right: n = 12; right-to-left: n = 12). Biomarker-compatible participants exhibited significantly lower baseline ADHD symptom severity (d
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