Tolerability of transcranial direct current stimulation in childhood-onset schizophrenia

doi:10.1016/j.brs.2011.01.001

Brain Stimulation

Volume 4, Issue 4, October 2011, Pages 275-280

https://doi.org/10.1016/j.brs.2011.01.001 Get rights and content

Background

In recent years, transcranial direct current stimulation (tDCS) has been used to study and treat many neuropsychiatric conditions. However, information regarding its tolerability in the pediatric population is lacking.

Objective

This study aims to investigate the tolerability aspects of tDCS in the childhood-onset schizophrenia (COS) population.

Methods

Twelve participants with COS completed this inpatient study. Participants were assigned to one of two groups: bilateral anodal dorsolateral prefrontal cortex (DLPFC) stimulation (n = 8) or bilateral cathodal superior temporal gyrus (STG) stimulation (n = 5). Patients received either 2 mA of active treatment or sham treatment (with possibility of open active treatment) for 20 minutes, for a total of 10 sessions (2 weeks).

Results

tDCS was well tolerated in the COS population with no serious adverse events occurring during the study.

Conclusions

This is the first study to demonstrate that a 20-minute duration of 2 mA of bilateral anodal and bilateral cathodal DC polarization to the DLPFC and STG was well tolerated in a pediatric population.

Section snippets

Participants

Twelve children/adolescents with COS completed the inpatient study; the sample included five boys and seven girls, ages (10-17 years). Participants had no history of significant neurologic illness. The guardians of participants provided written informed consent and COS subjects provided written assent before entering the study. This study was approved by the National Institutes of Health Neuroscience Institutional Review Board (IRB).

Study design

Participants were eligible for one of two study options.

Results

Of the 15 patients initially enrolled, two withdrew before randomization. One subject was randomly assigned to active temporal treatment but withdrew after 1 week of treatment because of a family issue that required her to return home. The remaining participants (five males, seven females) completed the entire study. Table 1 shows subject demographic and central nervous system (CNS) medication data. No subject asked to stop the study, required a change in CNS medications, or needed medical

Discussion

This pilot study, based on analyses of 125 tDCS sessions, is the first to demonstrate that tDCS is easily tolerated in adolescents. The most frequent side effect during active treatment was tingling (n = 6, 46.1%) or itching (n = 7, 53.8%) at the electrode sites. Several patients complained of fatigue (n = 4, 30.7%). However, this could be related to medication regimens that frequently include the atypical antipsychotic clozapine. As noted previously, no subjects asked to stop the study because

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The progression to psychotic disorders such as schizophrenia typically begins in adolescence, and these illnesses can have lasting impacts on an individual, families, and society. Because of the overlap with this critical developmental period, those who develop formal psychotic disorders during adolescence require specialized considerations. Further, within the last two decades, efforts to understand and treat psychosis have also shifted to identifying those earlier on in progression, prior to onset. Psychosis risk-syndromes typically emerge in adolescence and are characterized by attenuated symptoms, as well as progressive cognitive and social decline. A significant subgroup of these youth will go on to develop a formal psychotic disorder in a short 2-year period, and this creates a unique opportunity for mechanistic understanding and early intervention as well as potential prevention efforts. With this article, we provide an overview of adolescent-onset psychosis as well as psychosis-risk syndromes, review conceptualizations, and evaluate prediction, early identification and treatment targets in a developmental context. Furthermore, current and future intervention options for both groups are discussed.
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Despite these positive findings, a thorough screening for possible epileptic pathology is recommended even in a non-epileptic population (Splittgerber et al., 2020a). It has been commonly reported that tDCS does not cause serious adverse effects in young clinical populations, even if applied daily over a number of consecutive days (Mattai et al., 2011; Sotnikova et al., 2017). In studies in children with ADHD (Munz et al., 2015; Prehn-Kristensen et al., 2014), tDCS was applied during sleep.
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Crucial arguments in the debate about the use of transcranial electrical stimulation (tES) as an intervention for children with neurodevelopmental disorders include, besides safety and efficacy issues, neuroethical concerns as well. No agreement has been reached yet in the clinical community about the ethical aspects of stimulating, although not invasively, a developing brain. To investigate ethical concerns about the use of tES in childhood and adolescence, we explored the knowledge and opinions of practitioners (psychologists, pediatricians, child psychiatrists, and rehabilitators) working in the field of rehabilitation of neurodevelopmental disorders (N = 106). An online survey was designed to collect information about what practitioners in the neurodevelopmental field think about the therapeutic use of tES in terms of ethical concerns, need for facilitating conditions, openness to alternative treatments, and need for usability. Findings showed that a previous knowledge of tES, the presence of facilitating circumstances, and lower ethical concerns were the stronger predictors of clinical professionals' propensity to use tES for children rehabilitation. The present study is the first to explore the attitudes of clinical professionals toward the therapeutic use of tES in developmental populations, which we claim are useful for furthering the communication directed to the clinical community and its involvement in the discussion about tES-related issues.

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Original ArticleTolerability of transcranial direct current stimulation in childhood-onset schizophrenia

Background

Objective

Methods

Results

Conclusions

Section snippets

Participants

Study design

Results

Discussion

Brain Stimul

J Neurol Sci

Pain

Exp Neurol

Clin Neurophysiol

Clin Neurophysiol

Brain Res Bull

Clin Neurophysiol

Clin Neurophysiol

Clin Neurophysiol

Biol Psychiatry

Biol Psychiatry

Clin Neurophysiol

Clin Neurophysiol

Noninvasive human brain stimulation

Annu Rev Biomed Eng

rTMS strategies for the study and treatment of schizophrenia: a review

Int J Neuropsychopharmacol

Polarization of the human motor cortex through the scalp

Neuroreport

Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation

J Physiol

Original Article
Tolerability of transcranial direct current stimulation in childhood-onset schizophrenia