Systematic Review on the Safety and Tolerability of Transcranial Direct Current Stimulation in Children and Adolescents

Abstract

Background: Transcranial direct current stimulation (tDCS) is a safe, tolerable, and acceptable technique in adults. However, there is limited evidence for its safety in youth. Although limited, there are a handful of important empirical articles that have evaluated safety and tolerability outcomes in youth. However, a synthesis of pediatric safety studies is not currently available. Objective: To synthesize objective evidence regarding the safety and tolerability of pediatric tDCS based on the current state of the literature. Methods: Our search and report used PRISMA guidelines. Our method systematically examined investigations purposefully designed to evaluate the safety, tolerability, and acceptability of tDCS in healthy and atypical youth that were submitted to three databases, from the beginning of the database to November 2019. Safety considerations were evaluated by studies utilizing neuroimaging, physiological changes, performance on tasks, and by analyzing reported and objective side effects; tolerability via rate of adverse events; and acceptability via rate of dropouts. Results: We report on 203 sham sessions, 864 active sessions up to 2 mA, and 303 active hours of stimulation in 156 children. A total of 4.4% of the active sessions were in neurotypical controls, with the other 95.6% in clinical subjects. Conclusion: In spite of the fact that the current evidence is sporadic and scarce, the presently reviewed literature provides support for the safety, tolerability, and acceptability, of tDCS in youth for 1–20 sessions of 20 min up to 2 mA. Future pediatric tDCS research is encouraged.

Cerebellar Transcranial Direct Current Stimulation in Children with Autism Spectrum Disorder: A Pilot Study on Efficacy, Feasibility, Safety, and Unexpected Outcomes in Tic Disorder and Epilepsy

“…All participants underwent daily sessions of 1.0 mA 20 min tDCS on 20 consecutive weekdays [ 50 , 68 ]. We used a HDC stimulator (Newronika TM , Milan, Italy) connected to two 5 cm × 5 cm conductive-rubber electrodes.…”

“…tDCS can be used alone or in combination with other interventions, such as psychotherapy [ 47 ] or cognitive training [ 48 ]. In recent years, tDCS has also been used to treat children and adults with ASD, with no serious adverse events and encouraging results in terms of feasibility, efficacy, and tolerability [ 49 , 50 ]. Of particular interest, preliminary studies have shown tDCS to improve the core symptoms of ASD in addition to reducing behavioral symptoms [ 51 ].…”

Effects of Transcranial Direct Current Stimulation Treatment for Anorexia Nervosa

“…In addition, it analyzes the differences between the situation at the final stage of the study and at the beginning of the study ( = Stage 4 -Stage 1). Table 5 shows significant positive relationships between the changes in two questions in ZUNG (10,16) and negative associations with two questions of EDE-Q (4, 23). Compared with sham tDCS, active tDCS significantly improved self-evaluation based on one's body shape (EDE-Q 23) and significantly decreased the need of excessive control over calorie intake (EDE-Q 4) in a follow-up after 4 weeks (p < 0.05).…”

“…Transcranial direct current stimulation (tDCS) is a modern, well-tolerated method, which can be easily applied by trained personnel. It is assumed to be a safe technique (8)(9)(10), and the adverse effects are overall mild. The advantages of this method are low purchase costs and great therapeutic potential.…”

Repeated Sessions of Transcranial Direct Current Stimulation on Adolescents With Autism Spectrum Disorder: Study Protocol for a Randomized, Double-Blind, and Sham-Controlled Clinical Trial

“…As for potential risks of tDCS, guidelines report no serious adverse events in over 18,000 sessions of low-intensity transcranial electrical stimulation in pediatric and adult patients, as well as in healthy subjects ( 89 ). Current data also specifically emphasize the feasibility, tolerability, and safety of tDCS in children and adolescents ( 45 , 63 , 90 ). Adverse effects of tDCS in children and adolescents were described as mild and transient, including tingling (11.5%), itching (5.8%), redness (4.7%), and scalp discomfort (3.1%) ( 91 ).…”