Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) · 2025
Transcranial magnetic stimulation and transcranial direct current stimulation in psychiatric disorders in children and adolescents: an umbrella review of meta-analyses of clinical trials.
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Santos Jônatas Magalhães, Rodrigues Lívia Vita, da Silva Pedro Henrique Rodrigues, Razza Lais Boralli, Croarkin Paul E, Brunoni Andre Russowsky
Аннотация
OBJECTIVE: Non-invasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), shows promise for psychiatric disorders in adults, but evidence in children and adolescents remains limited. The objective of this review was to evaluate the efficacy and safety of non-invasive brain stimulation for treating psychiatric disorders in children and adolescents.
METHODS: An umbrella review with a pre-registered International Prospective Register of Systematic Reviews protocol (CRD42023477743) was conducted. Meta-analyses were identified using MeSH-based searches in Embase, PubMed, PsycINFO, and Cochrane up to October 30, 2023. The PICO strategy guided study selection. Study quality was assessed using A Measurement Tool to Assess Systematic Reviews, version 2, and evidence certainty was rated with GRADEpro.
RESULTS: Of 757 records screened, five meta-analyses, including 49 clinical trials and 2,105 participants, after excluding overlapped samples, met the inclusion criteria: four investigating rTMS for depression and one investigating transcranial direct current stimulation for attention-deficit hyperactivity disorder. Among the four meta-analyses on repetitive transcranial magnetic stimulation for depression, three had similar PICO criteria, and we prioritized the most recent with the largest number of trials and patients for formal evaluation. One meta-analysis (low quality) reported significant improvement in depressive symptoms at 2 (mean difference = 4.68/GRADE = low) and 4 (mean difference = 5.53/GRADE = low) weeks post-rTMS, with a positive response rate (OR = 3.99/GRADE = very low) and minimal adverse effects. Another (critically low quality) found significant symptom improvement in first-episode depression using 10 Hz stimulation on the left dorsolateral prefrontal cortex (standardized mean difference = 1.63/GRADE = low), 1 Hz stimulation on right dorsolateral prefrontal cortex (standardized mean difference = 1.22/GRADE = high), and remission rates (= 1.35/GRADE = moderate). The dropout rate was low, with no serious adverse events reported. A third (low quality) reported symptom improvement in attention-deficit hyperactivity disorder with transcranial direct current stimulation (standardized mean difference = 0.363/GRADE = very low).
CONCLUSION: Non-invasive brain stimulation appears to be a safe and effective treatment for psychiatric disorders in children and adolescents, but further high-quality randomized controlled trials are needed for clinical validation.
METHODS: An umbrella review with a pre-registered International Prospective Register of Systematic Reviews protocol (CRD42023477743) was conducted. Meta-analyses were identified using MeSH-based searches in Embase, PubMed, PsycINFO, and Cochrane up to October 30, 2023. The PICO strategy guided study selection. Study quality was assessed using A Measurement Tool to Assess Systematic Reviews, version 2, and evidence certainty was rated with GRADEpro.
RESULTS: Of 757 records screened, five meta-analyses, including 49 clinical trials and 2,105 participants, after excluding overlapped samples, met the inclusion criteria: four investigating rTMS for depression and one investigating transcranial direct current stimulation for attention-deficit hyperactivity disorder. Among the four meta-analyses on repetitive transcranial magnetic stimulation for depression, three had similar PICO criteria, and we prioritized the most recent with the largest number of trials and patients for formal evaluation. One meta-analysis (low quality) reported significant improvement in depressive symptoms at 2 (mean difference = 4.68/GRADE = low) and 4 (mean difference = 5.53/GRADE = low) weeks post-rTMS, with a positive response rate (OR = 3.99/GRADE = very low) and minimal adverse effects. Another (critically low quality) found significant symptom improvement in first-episode depression using 10 Hz stimulation on the left dorsolateral prefrontal cortex (standardized mean difference = 1.63/GRADE = low), 1 Hz stimulation on right dorsolateral prefrontal cortex (standardized mean difference = 1.22/GRADE = high), and remission rates (= 1.35/GRADE = moderate). The dropout rate was low, with no serious adverse events reported. A third (low quality) reported symptom improvement in attention-deficit hyperactivity disorder with transcranial direct current stimulation (standardized mean difference = 0.363/GRADE = very low).
CONCLUSION: Non-invasive brain stimulation appears to be a safe and effective treatment for psychiatric disorders in children and adolescents, but further high-quality randomized controlled trials are needed for clinical validation.