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Pediatric stroke and transcranial direct current stimulation: methods for rational individualized dose optimization
Bernadette T Gillick1, Adam Kirton2, Jason B Carmel3
1Department of Physical Medicine and Rehabilitation, Program in Physical Therapy, University of Minnesota, Medical School Minneapolis, MN, USA.
Insights
This study establishes child-specific transcranial direct current stimulation (tDCS) parameters for pediatric stroke, using computational modeling to ensure safety and efficacy in young patients.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Biomedical Engineering
Background:
- Transcranial direct current stimulation (tDCS) research is primarily in adults; pediatric dosing requires investigation.
- Perinatal stroke presents a promising application for tDCS in children.
- Child-specific tDCS dosage parameters are currently under development.
Purpose of the Study:
- To develop child-specific tDCS dosing parameters.
- To conduct a case study within a perinatal stroke tDCS safety and feasibility trial.
- To adapt adult tDCS protocols for pediatric use.
Main Methods:
- A 10-year-old with perinatal ischemic stroke and hemiparesis was studied.
- T1 MRI scans informed a computerized model for current flow and electrode placement.
- Dosing was optimized by considering adult trial data, brain current modeling, and safety factors.
Main Results:
- Modeled brain electric fields were compared to established predictions.
- An optimal intensity of 0.7 mA for 10 minutes with a C3/C4 montage was determined.
- The child tolerated the tDCS session, with no adverse events, confirming safety and feasibility.
Conclusions:
- Computational modeling can guide the rational customization of tDCS doses for pediatric stroke.
- This approach may enhance the design of future pediatric stroke tDCS trials.
- Establishing safe and effective pediatric tDCS protocols is crucial for clinical translation.
Background:
Transcranial direct current stimulation (tDCS) has been investigated mainly in adults and doses may not be appropriate in pediatric applications. In perinatal stroke where potential applications are promising, rational adaptation of dosage for children remains under investigation.
Objective:
Construct child-specific tDCS dosing parameters through case study within a perinatal stroke tDCS safety and feasibility trial.
Methods:
10-year-old subject with a diagnosis of presumed perinatal ischemic stroke and hemiparesis was identified. T1 magnetic resonance imaging (MRI) scans used to derive computerized model for current flow and electrode positions. Workflow using modeling results and consideration of dosage in previous clinical trials was incorporated. Prior ad hoc adult montages vs. de novo optimized montages provided distinct risk benefit analysis. Approximating adult dose required consideration of changes in both peak brain current flow and distribution which further tradeoff between maximizing efficacy and adding safety factors. Electrode size, position, current intensity, compliance voltage, and duration were controlled independently in this process.
Results:
Brain electric fields modeled and compared to values previously predicted models (Datta et al., 2011; Minhas et al., 2012). Approximating conservative brain current flow patterns and intensities used in previous adult trials for comparable indications, the optimal current intensity established was 0.7 mA for 10 min with a tDCS C3/C4 montage. Specifically 0.7 mA produced comparable peak brain current intensity of an average adult receiving 1.0 mA. Electrode size of 5 × 7 cm(2) with 1.0 mA and low-voltage tDCS was employed to maximize tolerability. Safety and feasibility confirmed with subject tolerating the session well and no serious adverse events.
Conclusion:
Rational approaches to dose customization, with steps informed by computational modeling, may improve guidance for pediatric stroke tDCS trials.
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