tDCS In Children Research Articles

Transcranial direct current stimulation (tDCS) in psychiatric disorders in early childhood (aged under 10 years): a systematic review.

Transcranial direct current stimulation (tDCS) remains experimental for many psychiatric disorders in adults. Particularly in childhood, there is limited research on the evidence for the efficacy and mechanisms of action of tDCS on the developing brain. The objective of this review is to identify published experimental studies to examine the efficacy and mechanisms of tDCS in children with psychiatric or developmental disorders in early (prepubertal) childhood (aged under 10 years). Included Studies should meet the following criteria: (1) experimental studies (no reviews, no case reports), (2) studies published in international peer-reviewed journals, (3) written in English, (4) conducted on children under 10 under years of age, (5) at enrolment with a psychiatric or developmental disorder.Eight studies were identified that fulfilled the specified criteria. All studies investigated effect on children with autism-spectrum-disorder (ASD). Anodal tDCS, mainly targeting the left dorsolateral prefrontal cortex (dlPFC), showed positive effects on the reduction of ASD symptoms. There has also been evidence that these stimulations are feasible, have good tolerability and are safe. tDCS was found to be safe and partially effective, but a long-term effect of tDCS and changes in connectivity during tDCS in autism has not been proven. Other developmental or psychiatric diseases were not investigated. This results in a lack of knowledge regarding the reactivity of the brain during the prepubertal period, which is a critical phase in the pathogenesis of neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD), ASD, Tourette's syndrome or dyslexia.

Methylphenidate is more effective to improve inhibitory control and working memory compared to tDCS in children and adolescents with attention deficit/hyperactivity disorder: a proof-of-concept study.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by an inappropriate, pervasive and persistent pattern of inattention, hyperactivity, and/or impulsivity and associated with substantial functional impairment. Despite considerable advances in the understanding and management of ADHD, some patients do not respond well to methylphenidate (MPH), the first-choice pharmacological treatment. Over the past decades, among non-invasive brain stimulation techniques, transcranial direct current stimulation (tDCS) has proven to be an effective and safe technique to improve behavior and cognition in children with neurodevelopmental disorders, including ADHD, by modifying cortical excitability. However, the effect of tDCS has never been directly compared with that of the MPH. The present randomized sham-controlled trial evaluated the effect of a single session of anodal tDCS compared with the administration of a single dose of MPH in children and adolescents with ADHD. After completing baseline assessment (T0), 26 children and adolescents with ADHD were exposed to 3 conditions with a 24-h interval-sessions: (A) a single session of anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC); (B) a single session of sham tDCS over the left DLPFC; (C) a single dose of MPH. Our results showed that after administering a single dose of MPH, children and adolescents with ADHD improved inhibitory control and visual-spatial WM compared with baseline, anodal, and sham tDCS. However, a single session of active tDCS over the left DLPFC was not effective compared with either baseline or sham tDCS. In conclusion, our protocol in ADHD involving a single tDCS session did not demonstrate consistent improvements in neurocognitive features compared with baseline, sham tDCS, or single MPH administration. Different protocols need to be developed to further test the effectiveness of tDCS in improving ADHD symptoms.

Home based remotely supervised tDCS in children with acquired brain injury: a feasibility study protocol

Home based remotely supervised tDCS in children with acquired brain injury: a feasibility study protocol

The application of High-Definition tDCS in children and adolescents with Autism Spectrum Disorder: a study protocol for a randomized, double-blind, sham-controlled clinical trial

The application of High-Definition tDCS in children and adolescents with Autism Spectrum Disorder: a study protocol for a randomized, double-blind, sham-controlled clinical trial

Modulation of auditory temporal processing, speech in noise perception, auditory-verbal memory, and reading efficiency by anodal tDCS in children with dyslexia

Dyslexia is a neurodevelopmental disorder that is prevalent in children. It is estimated that 30–50% of individuals diagnosed with dyslexia also manifest an auditory perceptual deficit characteristic of auditory processing disorder (APD). Some studies suggest that defects in basic auditory processing can lead to phonological defects as the most prominent cause of dyslexia. Thus, in some cases, there may be interrelationships between dyslexia and some of the aspects of central auditory processing. In recent years, transcranial direct current stimulation (tDCS) has been used as a safe method for the modulation of central auditory processing aspects in healthy adults and reading skills in children with dyslexia. Therefore, the objectives of our study were to investigate the effect of tDCS on the modulation of different aspects of central auditory processing, aspects of reading, and the relationship between these two domains in dyslexic children with APD. A within-subjects design was employed to investigate the effect of two electrode arrays (the anode on the left STG (AC)/cathode on the right shoulder and anode on the left STG/cathode on the right STG) on auditory temporal processing; speech-in-noise perception, short-term auditory memory; and high-frequency word, low-frequency word, pseudoword, and text reading. The results of this clinical trial showed the modulation of the studied variables in central auditory processing and the accuracy and speed of reading variables compared to the control and sham statuses in both electrode arrays. Our results also showed that the improvement of the accuracy and speed of text reading, as well as the accuracy of pseudoword reading were related to the improvement of speech in noise perception and temporal processing. The results of this research can be effective in clarifying the basis of the neurobiology of dyslexia and, in particular, the hypothesis of the role of basic auditory processing and subsequently the role of the auditory cortex in dyslexia. These results might provide a framework to facilitate behavioral rehabilitation in dyslexic children with APD.

Transcranial Direct Current Stimulation in Treatment of Child Neuropsychiatric Disorders: Ethical Considerations.

Transcranial direct current stimulation (tDCS) is a noninvasive electrical stimulation performed using low electric currents passing through two electrodes. The provided current passes from the anode to the cathode and induces electric fields in the surface neurons. It then modulates synaptic plasticity and finally changes cortical excitability or improves clinical outcomes, which outlast after a duration of stimulation. Meta-analyses have supported the beneficial effects of tDCS treatments in child neuropsychiatric disorders. However, the study of vulnerable children remains controversial and is a great deal for ethical considerations. Because the developing brain has some important physiological differences from the matured brain, specifically less γ-aminobutyric acid (GABA)ergic inhibition and more myelination, the opportunity to modify neurological disorders to be close to the normal level in childhood after tDCS is likely to be higher than in adults. In contrast, these physiological differences may result in unexpected excitability in children's brains and were criticized to have an unsafe effect, specifically seizures, which is a serious adverse events. As mentioned above, using tDCS in children appears to be a double-edged sword and should be ethically considered prior to wide use. Assessing between benefits of tDCS treatment within the golden period of brain development and the risk of seizure provocation is important. Thus, this perspective article is aimed to exhibit broad concepts about the developing brain, tDCS in children, pathophysiology of neuropsychiatric disorders and tDCS beneficence, tDCS safety and tolerability in children, and missing good opportunities or taking risks in tDCS.

Robotic Rehabilitation and Transcranial Direct Current Stimulation in Children With Bilateral Cerebral Palsy.

AimTo identify challenges of combining robotic upper extremity rehabilitation with tDCS in children with upper extremity bilateral cerebral palsy (CP) by assessing feasibility, tolerability and safety.MethodsThis was an unblinded, open-label, pilot clinical trial. Participants completed 10 × 1 h sessions of robotic rehabilitation combined with motor cortex anodal tDCS. Feasibility, acceptability and practicality, were assessed including the number of participants completing the protocol, factors limiting participation, time required for sessions, and completion of functional assessments and tolerability scales. To assess safety, standardized clinical and robotic measures of sensorimotor function were performed. The trial was registered at clinicaltrials.gov (NCT04233710).ResultsEight children were recruited (mean age 8y ± 1.8y, range 6–11 years) and 5 completed the intervention. There were no serious adverse events. One child developed focal seizures 6 weeks after the trial that were deemed to be unrelated. Barriers to completion included time and scheduling demands and patient factors, specifically cognitive/behavioral impairments and dyskinesia. No decline in clinical function was appreciated.ConclusionsRobotic upper extremity rehabilitation combined with tDCS may be feasible in children with bilateral CP. Careful participant selection, family engagement, and protocol adaptations are recommended to better understand the feasibility and tolerability of future trials.

Fronto-cerebellar tDCS in children with Autism Spectrum Disorder

Introduction Recent studies on autistic patients reportedan altered connectivity between prefrontal cortex and cerebellum. Disruption of specific cerebro-cerebellar networks interferes with the functional and structural specialization of cortical regions involved in motor control, language, and social interaction leading to the impairments found Autism Spectrum Disorder (ASD)(1). Transcranial Direct Current Stimulation (tDCS) is a safe, painless and easy-to-administer technique for the focal modulation of cortical brain areas, with negligible side-effects. Previous studies from our group showed the feasibility and efficacy of tDCS in reverting some of the behavioral symptoms of adult autistic patients. (2) The aim of the present study was to replicate those positive preliminary results using fronto-cerebellar tDCS in a sample of children with ASD. Methods Twenty patients (16 M, 4F) with ASD, aged 9 to 14 years, were randomized to receive either active or sham tDCS. Active treatment consisted in 20 daily sessions of 20 minutes/1.0 mA (age ≤ 10) or 1.5 mA (age > 11) tDCS. Sham was identical to active treatment except that the stimulation was stopped after 1 minute. The anode was placed in F3 and the cathode in the occipital region corresponding to the right cerebellum. During the treatment, no changes were made to the pharmacological and rehabilitative therapies in progress. Behavioral symptoms (Aberrant Behavior Checklist - ABC), effect of treatment (Autism Treatment Evaluation Checklist - ATEC), and parental stress (Parental Stress Index–PSI) were assessed just before and 1 week after the completion of the treatment. Results Seven patients in the active and 9 in the sham group completed the treatment. ABC and ATEC scores significantly decreased in the active group, while no change was observed in the sham group. Conclusion Our findings suggest that fronto-cerebellar tDCS may have a role for the treatment of children with ASD.

Unmet Needs in Children With Attention Deficit Hyperactivity Disorder-Can Transcranial Direct Current Stimulation Fill the Gap? Promises and Ethical Challenges.

Attention deficit hyperactivity disorder (ADHD) is a disorder most frequently diagnosed in children and adolescents. Although ADHD can be effectively treated with psychostimulants, a significant proportion of patients discontinue treatment because of adverse events or insufficient improvement of symptoms. In addition, cognitive abilities that are frequently impaired in ADHD are not directly targeted by medication. Therefore, additional treatment options, especially to improve cognitive abilities, are needed. Because of its relatively easy application, well-established safety, and low cost, transcranial direct current stimulation (tDCS) is a promising additional treatment option. Further research is needed to establish efficacy and to integrate this treatment into the clinical routine. In particular, limited evidence regarding the use of tDCS in children, lack of clear translational guidelines, and general challenges in conducting research with vulnerable populations pose a number of practical and ethical challenges to tDCS intervention studies. In this paper, we identify and discuss ethical issues related to research on tDCS and its potential therapeutic use for ADHD in children and adolescents. Relevant ethical issues in the tDCS research for pediatric ADHD center on safety, risk/benefit ratio, information and consent, labeling problems, and nonmedical use. Following an analysis of these issues, we developed a list of recommendations that can guide clinicians and researchers in conducting ethically sound research on tDCS in pediatric ADHD.

Influence of Combined Transcranial Direct Current Stimulation and Motor Training on Corticospinal Excitability in Children With Unilateral Cerebral Palsy.

Combined non-invasive brain stimulation (NIBS) and rehabilitation interventions have the potential to improve function in children with unilateral cerebral palsy (UCP), however their effects on developing brain function are not well understood. In a proof-of-principle study, we used single-pulse transcranial magnetic stimulation (TMS) to measure changes in corticospinal excitability and relationships to motor performance following a randomized controlled trial consisting of 10 days of combined constraint-induced movement therapy (CIMT) and cathodal transcranial direct current stimulation (tDCS) applied to the contralesional motor cortex. Twenty children and young adults (mean age = 12 years, 9 months, range = 7 years, 7 months, 21 years, 7 months) with UCP participated. TMS testing was performed before, after, and 6 months after the intervention to measure motor evoked potential (MEP) amplitude and cortical silent period (CSP) duration. The association between neurophysiologic and motor outcomes and differences in excitability between hemispheres were examined. Contralesional MEP amplitude decreased as hypothesized in five of five participants receiving active tDCS immediately after and 6 months after the intervention, however no statistically significant differences between intervention groups were noted for MEP amplitude [mean difference = −323.9 μV, 95% CI = (−989, 341), p = 0.34] or CSP duration [mean difference = 3.9 ms, 95% CI = (−7.7, 15.5), p = 0.51]. Changes in corticospinal excitability were not statistically associated with improvements in hand function after the intervention. Across all participants, MEP amplitudes measured in the more-affected hand from both contralesional (mean difference = −474.5 μV) and ipsilesional hemispheres (−624.5 μV) were smaller compared to the less-affected hand. Assessing neurophysiologic changes after tDCS in children with UCP provides an understanding of long-term effects on brain excitability to help determine its potential as a therapeutic intervention. Additional investigation into the neurophysiologic effects of tDCS in larger samples of children with UCP are needed to confirm these findings.

The Therapeutic Potential of Non-invasive Neurostimulation for Motor Skill Learning in Children with Neurodevelopmental Disorders

Non-invasive neurostimulation is becoming increasingly popular in rehabilitation, as it may enhance the brain’s natural learning processes, potentially increasing the effectiveness of movement interventions. The current paper provides a review of studies that have investigated the application of transcranial direct current stimulation (tDCS) in pediatric populations with neurodevelopmental disorders (NDD) complicated by motor impairment. Proof of principle studies indicate that tDCS can positively influence motor learning in children. The application of tDCS across pediatric populations with NDD is in its early stages. We emphasize the need for caution and further research investigating the therapeutic potential of tDCS in children with NDD and motor impairment. Indications of efficacy will require carefully designed trials before conclusions of effectiveness can be made. Optimal tDCS protocols may differ across both disorders and individuals. Protocol parameters which produce clinically significant improvements will become clearer with further high-quality evidence.

Transcranial direct current stimulation in children with autism spectrum disorder: a systematic scoping review.

Our aim was to review available studies which test transcranial direct current stimulation (tDCS) to reduce symptom severity in children with autism spectrum disorder (ASD). We performed a systematic scoping review in PubMed and PsychINFO databases for studies employing tDCS in children and adolescents with ASD. We found five studies (two small randomized controlled studies, one experimental study, one quasi-experimental study, and one case study) reporting positive effects of tDCS in ASD symptom reduction. Study design varied greatly and sample size ranged from 1 to 20 patients. Preliminary evidence is encouraging of the potential usefulness of tDCS for treatment of ASD in children and adolescents. It suggests tentative support for reductions in symptom severity and, according to parental reports and clinical observations, improvements in some aspects of language. However, the evidence is sparse and of low quality, so the true effect of tDCS is likely to be substantially different from the estimate of effect in this review. Therefore, future randomized controlled trials are needed to draw conclusions regarding tDCS efficacy in paediatric samples with ASD. There is low confidence in the estimate of effect, but tentatively encouraging results warrant further investigation.

Effects of High-Definition and Conventional Transcranial Direct-Current Stimulation on Motor Learning in Children.

Background: Transcranial direct current stimulation (tDCS) can improve motor learning in children. High-definition approaches (HD-tDCS) have not been examined in children.Objectives/Hypothesis: We hypothesized that primary motor cortex HD-tDCS would enhance motor learning but be inferior to tDCS in children.Methods: Twenty-four children were recruited for a randomized, sham-controlled, double-blinded interventional trial (NCT03193580, clinicaltrials.gov/ct2/show/NCT03193580) to receive (1) right hemisphere (contralateral) primary motor cortex (M1) 1 mA anodal conventional 1 × 1 tDCS (tDCS), (2) right M1 1 mA anodal 4 × 1 HD-tDCS (HD-tDCS), or (3) sham. Over five consecutive days, participants trained their left hand using the Purdue Pegboard Test (PPTL). The Jebsen–Taylor Test, Serial Reaction Time Task, and right hand and bimanual PPT were also tested at baseline, post-training, and 6-week retention time (RT).Results: Both the tDCS and HD-tDCS groups demonstrated enhanced motor learning compared to sham with effects maintained at 6 weeks. Effect sizes were moderate-to-large for tDCS and HD-tDCS groups at the end of day 4 (Cohen’s d tDCS = 0.960, HD-tDCS = 0.766) and day 5 (tDCS = 0.655, HD-tDCS = 0.851). Enhanced motor learning effects were also seen in the untrained hand. HD-tDCS was well tolerated and safe with no adverse effects.Conclusion: HD-tDCS and tDCS can enhance motor learning in children. Further exploration is indicated to advance rehabilitation therapies for children with motor disabilities such as cerebral palsy.Clinical Trial Registration: clinicaltrials.gov, identifier NCT03193580.

F141. Sensorimotor robotic measures of tDCS and HD-tDCS enhanced motor learning in children

Perinatal stroke causes hemiparetic cerebral palsy (CP) and lifelong disability. Treatments are limited but non-invasive brain stimulation, such as transcranial direct-current stimulation (tDCS) can alter cortical excitability, providing a unique opportunity for therapeutic neuromodulation in CP. We have demonstrated that application of tDCS can enhance motor skill acquisition in children. Growing evidence suggests that tDCS is safe in pediatrics, however refined forms of stimulation such as high-definition (HD)-tDCS have not been applied in children. The KINARM robot objectively quantifies sensorimotor function and holds potential to examine functional changes associated with tDCS-paired motor learning. We aimed to characterize changes in sensorimotor function induced by tDCS and HD-tDCS paired motor learning in children. We hypothesized that application of tDCS and HD-tDCS will improve motor function (visually-guided reaching; VGR), but only tDCS will improve sensory function (position matching). AMPED (Accelerated motor learning in pediatrics) is a randomized, sham-controlled trial (ClinicalTrials.gov: NCT03193580). Healthy, right-handed children (12–18y) were recruited. A validated 4-stage KINARM protocol and a series of motor function assessments [Purdue Pegboard Test (PPT), Jebsen Taylor Test, and Serial Reaction Time Task] were completed at baseline, post-training, and six weeks later. Participants were randomized to receive sham tDCS, anodal tDCS, or anodal HD-tDCS targeting the right primary motor cortex. Over five consecutive days, participants trained their left hand on the PPT during stimulation. Safety and tolerability was assessed daily. Group differences were explored using repeated measure ANOVA with post hoc correcting for multiple comparisons. To date, 15 of 24 participants have completed the study (median 16.4y, range 12–18y, 67% female). Blinded interim analysis of cases grouped by intervention (group A, B, C) was performed on an exploratory basis. All participants improved their left hand PPT scores (p < 0.001) regardless of intervention. The mean improvement in left hand PPT scores was 3.93 ± 1.33 pegs and was comparable across the groups: A 4.33 ± 1.78, B 3.08 ± 1.15, C 3.67 ± 1.18. No difference was observed between the groups. Right hand PPT scores increased (Group A p = 0.009) or were unchanged (both p > 0.06). Position matching performance did not change from baseline to post-training. Group A demonstrated improvements in left hand reaction (p = 0.03) and movement time (p = 0.04) in VGR tasks between baseline and post-training. All procedures were well tolerated with no adverse events reported. Application of tDCS and HD-tDCS in healthy children is safe, feasible, and tolerable. Sensorimotor function may be altered by tDCS and HD-tDCS paired with motor training. Optimizing tDCS and HD-tDCS protocols while exploring mechanisms of action is essential to advance therapeutic applications of tDCS in children with CP and other motor disabilities.

1 mA cathodal tDCS shows excitatory effects in children and adolescents: Insights from TMS evoked N100 potential

In children and adolescents, 1 mA transcranial direct current stimulation (tDCS) may cause “paradoxical” effects compared with adults: both 1 mA anodal and cathodal tDCS increase amplitude of the motor evoked potential (MEP) as revealed by a single pulse transcranial magnetic stimulation (TMS) of the motor cortex. Here, EEG based evoked potentials induced by a single pulse TMS, particularly the N100 component as marker of motor cortex inhibition, were investigated in order to explain effects of tDCS on the developing brain. In nineteen children and adolescents (11–16 years old), 1 mA anodal, cathodal, or sham tDCS was applied over the left primary motor cortex for 10 min. The TMS-evoked N100 was measured by 64-channel EEG before and immediately after stimulation as well as every 10 min after tDCS for one hour. 1 mA Cathodal stimulation suppressed the N100 amplitude compared with sham stimulation. In contrast, anodal tDCS did not modify the N100 amplitude. It seems likely that the increase of the motor cortex activity under cathodal tDCS in children and adolescents as shown in previous studies can be attributed to a reduce inhibition. Based on TMS evoked N100, the study provides an insight into neuromodulatory effects of tDCS on the developing brain.

Transcranial direct current stimulation in children and adolescents: a comprehensive review

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method that has shown promising results in various neuropsychiatric disorders in adults. This review addresses the therapeutic use of tDCS in children and adolescents including safety, ethical, and legal considerations. There are several studies addressing the dosage of tDCS in children and adolescents by computational modeling of electric fields in the pediatric brain. Results suggest halving the amperage used in adults to obtain the same peak electric fields, however, there are some studies reporting on the safe application of tDCS with standard adult parameters in children (2mA; 20-30min). There are several randomized placebo controlled trials suggesting beneficial effects of tDCS for the treatment of cerebral palsy. For dystonia there are mixed data. Some studies suggest efficacy of tDCS for the treatment of refractory epilepsy, and for the improvement of attention deficit/hyperactivity disorder and autism. Interestingly, there is a lack of data for the treatment of childhood and adolescent psychiatric disorders, i.e., childhood onset schizophrenia and affective disorders. Overall, tDCS seems to be safe in pediatric population. More studies are needed to confirm the preliminary encouraging results; however, ethical deliberation has to be weighed carefully for every single case.

Transcranial Direct Current Stimulation in Child and Adolescent Psychiatry.

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that consists of applying a weak electric current over the scalp to modulate cortical excitability. tDCS has been extensively investigated in adults with psychiatric disorders. The aim of this study was to review the current literature regarding the use of tDCS in children and adolescents with psychiatric disorders. We searched MEDLINE and EMBASE databases for studies evaluating the safety and efficacy of tDCS in children and adolescents from age 0 to 18 years with psychiatric disorders. We found six studies that evaluated patients with different psychiatric disorders, with diverse study designs and stimulation parameters, including three small randomized clinical trials (RCTs), one evaluating childhood-onset schizophrenia, one RCT with patients with autism spectrum disorders (ASD), and one study in attention-deficit/hyperactivity disorder (ADHD); three open-label studies, two evaluating patients with ASD, and one study of feasibility of the technique in children and adolescents with language disorders and diverse psychiatric disorders, including ASD, intellectual disability, and ADHD. We also found three studies of dosage considerations in the general pediatric population. The technique was well tolerated, with no reports of serious side effects. Preliminary research suggests that tDCS may be well tolerated and safe for children and adolescents with psychiatric and neurodevelopmental disorders. Nevertheless, because the literature regarding tDCS in child and adolescent psychiatry is scarce and there exist limited numbers of randomized controlled trials, it is not possible to draw definite conclusions. Future studies should investigate the technique with regard to specific psychiatric conditions in comparison with standard treatments. In addition, long-term efficacy and safety should be monitored.

Safety and feasibility of transcranial direct current stimulation in pediatric hemiparesis: randomized controlled preliminary study.

Transcranial direct current stimulation (tDCS) is a form of noninvasive brain stimulation that has shown improved adult stroke outcomes. Applying tDCS in children with congenital hemiparesis has not yet been explored. The primary objective of this study was to explore the safety and feasibility of single-session tDCS through an adverse events profile and symptom assessment within a double-blind, randomized placebo-controlled preliminary study in children with congenital hemiparesis. A secondary objective was to assess the stability of hand and cognitive function. A double-blind, randomized placebo-controlled pretest/posttest/follow-up study was conducted. The study was conducted in a university pediatric research laboratory. Thirteen children, ages 7 to 18 years, with congenital hemiparesis participated. Adverse events/safety assessment and hand function were measured. Participants were randomly assigned to either an intervention group or a control group, with safety and functional assessments at pretest, at posttest on the same day, and at a 1-week follow-up session. An intervention of 10 minutes of 0.7 mA tDCS was applied to bilateral primary motor cortices. The tDCS intervention was considered safe if there was no individual decline of 25% or group decline of 2 standard deviations for motor evoked potentials (MEPs) and behavioral data and no report of adverse events. No major adverse events were found, including no seizures. Two participants did not complete the study due to lack of MEP and discomfort. For the 11 participants who completed the study, group differences in MEPs and behavioral data did not exceed 2 standard deviations in those who received the tDCS (n=5) and those in the control group (n=6). The study was completed without the need for stopping per medical monitor and biostatisticial analysis. A limitation of the study was the small sample size, with data available for 11 participants. Based on the results of this study, tDCS appears to be safe, feasible, and well tolerated in most children with hemiparesis. Future investigations of serial sessions of tDCS in conjunction with rehabilitation in pediatric hemiparesis are indicated to explore the benefit of a synergistic approach to improving hand function.

Dosage Considerations for Transcranial Direct Current Stimulation in Children: A Computational Modeling Study

Transcranial direct current stimulation (tDCS) is being widely investigated in adults as a therapeutic modality for brain disorders involving abnormal cortical excitability or disordered network activity. Interest is also growing in studying tDCS in children. Limited empirical studies in children suggest that tDCS is well tolerated and may have a similar safety profile as in adults. However, in electrotherapy as in pharmacotherapy, dose selection in children requires special attention, and simple extrapolation from adult studies may be inadequate. Critical aspects of dose adjustment include 1) differences in neurophysiology and disease, and 2) variation in brain electric fields for a specified dose due to gross anatomical differences between children and adults. In this study, we used high-resolution MRI derived finite element modeling simulations of two healthy children, ages 8 years and 12 years, and three healthy adults with varying head size to compare differences in electric field intensity and distribution. Multiple conventional and high-definition tDCS montages were tested. Our results suggest that on average, children will be exposed to higher peak electrical fields for a given applied current intensity than adults, but there is likely to be overlap between adults with smaller head size and children. In addition, exposure is montage specific. Variations in peak electrical fields were seen between the two pediatric models, despite comparable head size, suggesting that the relationship between neuroanatomic factors and bioavailable current dose is not trivial. In conclusion, caution is advised in using higher tDCS doses in children until 1) further modeling studies in a larger group shed light on the range of exposure possible by applied dose and age and 2) further studies correlate bioavailable dose estimates from modeling studies with empirically tested physiologic effects, such as modulation of motor evoked potentials after stimulation.

Transcranial Direct Current Stimulation for Treatment of Refractory Childhood Focal Epilepsy

BackgroundCathodal transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation method for suppressing regional cortical excitability. We examine the safety and antiepileptic efficacy of cathodal tDCS in children with refractory focal epilepsy. Although a prior cathodal tDCS trial in adults with epilepsy revealed EEG improvement, neither the antiepileptic potential nor the safety and tolerability of tDCS has been tested in children. MethodThe study consisted of three phases: 1) a 4-week pre-treatment monitoring period with vital sign measures, EEG, seizure diary, and baseline quality of life (QOL) questionnaire; 2) a single treatment with 1 mA cathodal tDCS for 20 min with cathode positioned over the seizure focus and anode on the contralateral shoulder; 3) follow-ups immediately after stimulation, and at 24, 48 h, and 4 weeks after tDCS with continued seizure diary and epileptic discharge counts on EEG; the QOL questionnaire was also repeated 4 weeks after stimulation. Patients were randomized to receive either single session active or sham tDCS 1 mA, 20 min. ResultsThirty six children (6–15 years) with focal epilepsy were enrolled, 27 in active and 9 in sham group. All patients tolerated tDCS well. No serious adverse events occurred. Active tDCS treatment was associated with significant reductions in epileptic discharge frequency immediately and 24 and 48 h after tDCS. Four weeks after treatment, a small (clinically negligible but statistically significant) decrease in seizure frequency was also detected. ConclusionA single session of cathodal tDCS improves epileptic EEG abnormalities for 48 h and is well-tolerated in children.