Non-invasive brain stimulation: a promising approach for psychiatricdisorders in children and adolescents?

Resumo

Non-invasive brain stimulation (NIBS) encompasses a range of techniques that use electric or magnetic current aiming to modulate neural circuits (Brunoni et al. 2019). These methods, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), show promise as effective treatment options for various psychiatric conditions in adults and are safe and well tolerated (Brunoni et al. 2019). However, there is currently a lack of comprehensive quantitative and qualitative analysis regarding the effectiveness of NIBS for numerous mental health conditions in children and adolescents.

In that regard, Santos et al. performed the first umbrella review on the efficacy and safety of non-invasive brain stimulation in treating psychiatric disorders in children and adolescents, a revolutionary contribution to infant psychiatry. The study design, made with a search strategy composed of a combination of terms that represents: i. psychiatric disorders (based on ICD-10 and DSM-5 classification); ii: intervention (TMS/tDCS); iii. population (adolescents/child); and iv.  publication type (review), made it possible to get an overview of the current evidence regarding the use of these techniques. The review showed that rTMS can improve depressive symptoms, including for first-episode depression, and is generally tolerable for infant patients. Also, tDCS was seen as effective and tolerable to treat children and adolescents with ADHD. Thus, by consolidating data from meta-analyses of clinical trials, this work brings the potential of NIBS techniques, especially repetitive rTMS and tDCS, to address psychiatric disorders in younger populations.

However, although the review showed evidence for the use of TMS and tDCS to treat depression and ADHD, other combinations of NIBS techniques and psychiatric disorder were not found through the systematic review. Furthermore, the review highlights some limitations, including the heterogeneity of studies and small sample sizes, leading to a very-low to moderate certainty of evidence according to the GRADE approach (Guyatt et al. 2008). These gaps reinforce the need for well-designed, multicentric trials to better define NIBS protocols for young, developing brains.