NON-INVASIVE BRAIN STIMULATION IN PSYCHIATRIC DISORDERS IN CHILDREN AND ADOLESCENTS: AN UMBRELLA REVIEW OF META-ANALYSES OF CLINICAL TRIALS

• Grant number: 23/10454-0
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: October 01, 2023
• End date: September 30, 2024
• Field of knowledge: Health Sciences - Medicine - Psychiatry
• Principal Investigator: Andre Russowsky Brunoni
• Grantee: Jônatas Magalhães Santos
• Host Institution: Instituto de Psiquiatria Doutor Antonio Carlos Pacheco e Silva (IPq). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil

Abstract

Psychiatric disorders are important causes of disability around the world. When occur in children and adolescents, frequently are late diagnosed and suboptimal treated, culminating in a chronification of the disease. Treatment options vary according to the disorder and range from exclusively non-pharmacological approaches - as in the case of autism spectrum disorder - to a combined therapy of psychotherapy and pharmacotherapy - as in the case of depression. However, there are problems with existing treatments for children and adolescents, among which we can mention high rates of refractoriness and increased suicidality. Thus, the development of new therapeutic strategies is necessary.Neuromodulation encompasses a set of technologies and techniques in the field of medicine and bioengineering capable of acting directly on neurons, modulating them according to the therapeutic objective. Several neuromodulation techniques are already used in clinical practice, whether they are convulsive, invasive, or non-invasive techniques. Existing evidence shows the efficacy and safety of using these techniques in adults, with emphasis on transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), non-invasive brain stimulation (NIBS) modalities.The literature describes the use of TMS and tDCS in children and adolescents for various psychiatric disorders. The use of TMS in adolescent depression is widely studied and associated with clinical improvement in meta-analyses. In other conditions, the use of TMS appears to be associated with clinical improvement in autism spectrum disorder, attention deficit hyperactivity disorder and schizophrenia, however most descriptions are limited to case reports; the same occurs for the use of tDCS.Therefore, although the existing evidence in the literature is promising, more studies are needed in the pediatric age group so that these neuromodulation techniques are incorporated into the medical reality.