Efficacy of Adjunctive High Frequency Repetitive Transcranial Magnetic Stimulation of Right Prefrontal Cortex in Adolescent Mania: A Randomized Sham-Controlled Study

Abstract

ObjectiveTo examine the efficacy of adjunctive right prefrontal high-frequency repetitive transcranial magnetic stimulation (rTMS) treatment in adolescent mania patients as compared to sham stimulation.MethodsTwenty six right handed patients aged 12–17 years diagnosed with bipolar mania were randomized to receive daily sessions of active or sham rTMS (20 Hz, 110% of motor threshold, 20 trains, 10 s intertrain interval) over the right dorsolateral prefrontal cortex for 10 days. Mania was rated using Young Mania Rating Scale (YMRS) and Clinical Global Impression (CGI) at baseline, and after 5th and 10th rTMS.ResultsFor YMRS scores, repeated measures analysis of variance (ANOVA) showed a significant main effect (F=44.49, degree of freedom [df]=1.2/29.29, p<0.001, Greenhouse-Geisser corrected, effect size η2=0.65), but the interaction effect was not significant (F=0.03, df=1.2/29.29, p=0.912, Greenhouse-Geisser corrected). For CGI-Severity, repeated measures ANOVA showed a significant main effect (F=24.49, df=1.42/34.21, p<0.001, Greenhouse-Geisser corrected, effect size η2=0.51), but the interaction effect was not significant (F=0.06, df=1.2/29.29, p=0.881, Greenhouse-Geisser corrected).ConclusionHigh-frequency right prefrontal rTMS was found to be ineffective as add-on to standard pharmacotherapy in adolescent mania.

Safety of Transcranial Magnetic Stimulation in Children: A Systematic Review of the Literature

“…There were 81 adverse events that were attributed to rTMS protocols in the CNS disorder population (Table 2). The mild adverse events were as follows: headache (n=45) 15, 21, 64, 69-71, 75, 78 , dizziness (n=8) 66, 69, 70 , jaw twitching (n=4) 66 , nausea/vomiting (n=4) 21, 75 , anxiety (n=3) 69 , neck stiffness (n=3) 21 , tingling/dullness (n=3) 69, 75 , scalp pain (n=2) 13, 67 , neck pain (n=2) 70 , restlessness (n=1) 77 , and sleepiness (n=1) 14 . Moderate adverse events include generalized tonic-clonic seizure (n=3) 65, 68, 72 and rapid moodswings (n=1) 77 .…”

Clinical applications of transcranial magnetic stimulation in bipolar disorder

“…Only two studies of TMS for mania noted that patients reported side effects; across these studies, patients experienced pain during their procedure (which went away after session completion), dizziness, anxiety, and a brief headache following treatment (Pathak et al, 2015;Praharaj et al, 2009). Only two studies of TMS for mania noted that patients reported side effects; across these studies, patients experienced pain during their procedure (which went away after session completion), dizziness, anxiety, and a brief headache following treatment (Pathak et al, 2015;Praharaj et al, 2009).…”

“…Patients who received the active treatment demonstrated significant improvements in mania (as evaluated via the YMRS (Young et al, 1978)) relative to the sham group (Praharaj, Ram, & Arora, 2009). However, a follow-up study employing an identical protocol in an adolescent sample found no significant differences in mania outcomes between the active and sham groups (Pathak, Sinha, & Praharaj, 2015). The authors suggest that the discrepant findings between the two studies may be accounted for by metabolic differences between adults and chil- Abbreviations: CGI, Clinical Global Impressions Scale (Spearing et al, 1997); HAM-D, Hamilton Rating Scale for Depression (Hamilton, 1960); MADRS, Montgomery-Asberg Depression Rating Scale (Montgomery & Asberg, 1979); TMS, transcranial magnetic stimulation.…”

“…After the two-week treatment period, patients demonstrated a significant improvement in manic symptoms (as evaluated via the Mania Assessment Scale and CGI (Spearing et al, 1997)) (Saba et al, 2004). However, a follow-up study employing an identical protocol in an adolescent sample found no significant differences in mania outcomes between the active and sham groups (Pathak, Sinha, & Praharaj, 2015). Patients who received the active treatment demonstrated significant improvements in mania (as evaluated via the YMRS (Young et al, 1978)) relative to the sham group (Praharaj, Ram, & Arora, 2009).…”

“…However, if adolescents do not exhibit this pattern of metabolic activity, they may not be as likely to respond to rTMS over their right DLPFC (Pathak et al, 2015).…”