Pediatric Neuromodulation Comes of Age

Abstract

This special issue surveys recent work and underscores the challenges of psychiatric brain stimulation research with child and adolescent populations. The field of child and adolescent psychopharmacology is replete with examples of potential pitfalls in the assumption that ''children are little adults.'' Arguably, younger age portends more neurobiological and descriptive heterogeneity in research pursuits and clinical practice. For existing brain stimulation modalities, there are a paucity of translational models to design studies for youth and no well-studied dosing schemes. The long-term positive and negative effects of neuromodulation interventions in youth are unknown. Inherent pragmatic and ethical limitations often present barriers for participant recruitment and will necessitate innovative approaches to study design and team efforts. These challenges are not insurmountable, and sustained efforts will advance the growing field of pediatric neuromodulation.

Transcranial Magnetic Stimulation for Adolescent Depression

“…35,48 However, at present there are many unknowns regarding optimal stimulation parameters and potential biomarkers for depressed adolescents receiving TMS. 11,16 Later this year, a National Institute of Mental Health funded, dose-finding, biomarker validation, and effectiveness study of 1 Hz vs. 10 Hz TMS for adolescents with depression will begin enrollment with the aim of addressing these questions (NIMH R01MH113700). 49…”

“…13–15 Early adolescent research was informed by this approach but there is a formidable parameter space (for example, coil location, frequency, intensity, duration of treatment, concurrent interventions, and brain state during treatment) to consider for TMS treatment. 16,17 The heterogeneity of depression in adolescents arguably presents an added layer of complexity. 1,16,18…”

“…16,17 The heterogeneity of depression in adolescents arguably presents an added layer of complexity. 1,16,18…”

Neuroethics of neuromodulation: An update

“…Yet Johnco and Storch[40] note the lack of a standardized definition of “refractory” when considering DBS or other neurodevices, and that the use of invasive neuromodulation in pediatric populations is in need of more thorough clinical and ethical analysis. The articles discussing pediatric DBS note concerns about the scarcity of clinical studies and data with minors, including little information about long-term effects, concerns about safety and informed consent, potential effects on agency of developing minors, and the use of neuromodulation tools to attempt to enhance healthy children[40] [41] [42] [43] [44] [45] [46] [47] [48] [49]. …”

“…Informed consent and agency presents a special set of challenges: who determines what is in the best interest of the child, and who gets to make the final decision about whether neuromodular interventions are used on children? Croarkin et al note the difficulty in recruiting youth in neuromodulation studies and the lack of translational studies, resulting in little data about appropriate dosing [48]. Furthermore, some studies suggest that by age 12 children may have decision-making capacity for medical interventions and research participation and that they should play a more prominent role in these complicated decisions[52] [53].…”