Safety of Noninvasive Brain Stimulation in Children and Adolescents

Abstract

Background Noninvasive brain stimulation (NIBS) techniques such as transcranial magnetic stimulation (TMS) and transcranial current stimulation (tCS) have the potential to mitigate a variety of symptoms associated with neurological and psychiatric conditions, including stroke, cerebral palsy, autism, depression, and Tourette syndrome. While the safety of these modalities has been established in adults, there is a paucity of research assessing the safety of NIBS among children. Objective To examine the existing literature regarding the safety of NIBS techniques in children and adolescents with neurologic and neuropsychiatric disorders. Methods An electronic search was performed on online databases for studies using NIBS in individuals less than 18 years of age. Non-English publications, diagnostic studies, electroconvulsive therapy, single/dual pulse TMS studies, and reviews were excluded. Adverse events reported in the studies were carefully examined and synthesized to understand the safety and tolerability of NIBS among children and adolescents. Results The data from 48 studies involving more than 513 children/adolescents (2.5–17.8 years of age) indicate that the side-effects of NIBS were, in general, mild and transient [TMS: headache (11.5%), scalp discomfort (2.5%), twitching (1.2%), mood changes (1.2%), fatigue (0.9%), tinnitus (0.6%); tCS: tingling (11.5%), itching (5.8%), redness (4.7%), scalp discomfort (3.1%)] with relatively few serious adverse events. Conclusion Our findings indicate that both repetitive TMS and tCS are safe modalities in children and adolescents with various neurological conditions, especially when safety guidelines are followed. The incidence of adverse events appears to be similar to that observed in adults; however, further studies with longer treatment and follow-up periods are needed to better understand the benefits and tolerance of long-term use of NIBS in children.

Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex enhances working memory

“…Finally, even when following the strict safety guidelines for TMS, general and transient side effects such as headache, mood changes, and tinnitus have been reported (Krishnan et al 2015). The most serious adverse event of TMS is the risk of triggering epileptic seizures (Bostrom and Sandberg 2009) which can be less than 1/1000 (Machii, et al 2006) in healthy subjects (Machii et al 2006;Rossi et al 2009;Krishnan et al 2015).…”

“…The most serious adverse event of TMS is the risk of triggering epileptic seizures (Bostrom and Sandberg 2009) which can be less than 1/1000 (Machii, et al 2006) in healthy subjects (Machii et al 2006;Rossi et al 2009;Krishnan et al 2015). In this study, we used previously established safe TMS protocols (10 Hz frequency; 100 % motor threshold intensity; long inter-train interval).…”

Applications of transcranial direct current stimulation in children and pediatrics

“…Although tDCS could be used to modulate pathological cortical states both in adults and children, special precautions are necessary in childhood because the medium-and long-term consequences of the plastic changes induced by tDCS in the developing brain are not well known. From investigations in which safety and tolerability of tDCS have been specifically explored, data indicate that the currently applied protocols are safe and well tolerated (Andrade et al, 2014;Ekici, 2015;Krishnan et al, 2015;Bikson et al, 2016) when exclusion criteria are taken into account. Studies about the use of tDCS in children report no serious adverse effects (see Table 1).…”

Seizure Induced by Deep Transcranial Magnetic Stimulation in an Adolescent with Depression

“…Although TMS is thought to be generally safe in children and adolescents (Krishnan et al 2015), there is a dearth of research about the use of TMS as a treatment for adolescent depression.…”