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Tolerability and Effectiveness of Cathodal Transcranial Direct Current Stimulation in Children with Refractory
Soumya Ghosh1,2, Lakshmi Nagarajan1,3
1Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Nedlands, WA 6009, Australia.
Insights
This pilot study explored cathodal transcranial direct current stimulation (tDCS) for pediatric drug-resistant epilepsy (DRE). While two children showed seizure reduction or improved alertness, further research is needed to optimize tDCS parameters for diverse epilepsy types.
Area of Science:
- Neurology
- Neuroscience
- Pediatric Epilepsy
Background:
- Pediatric drug-resistant epilepsy (DRE) presents significant challenges due to limited effective treatment options.
- Investigating novel therapeutic modalities is crucial for improving outcomes in children with DRE.
Purpose of the Study:
- To assess the tolerability and effectiveness of cathodal transcranial direct current stimulation (tDCS) as a potential treatment for pediatric DRE.
- To evaluate both short-term and longer-term effects of tDCS on seizure frequency, severity, and overall well-being.
Main Methods:
- A pilot study involving twelve children diagnosed with DRE of various etiologies.
- Participants received three to four daily sessions of cathodal tDCS.
- Seizure frequency was monitored via diaries pre- and post-tDCS; clinical reviews and EEG analyses (Spike Wave Index) were conducted.
Main Results:
- One child achieved a year of seizure freedom; another experienced reduced ICU admissions due to less severe seizures.
- Four children reported transient improvements in alertness and mood lasting 2-4 weeks.
- No significant benefits were observed in the remaining participants; no serious adverse effects were reported.
Conclusions:
- Cathodal tDCS demonstrated potential tolerability and some efficacy in a subset of children with DRE.
- The study highlights the need for personalized tDCS stimulus parameters tailored to specific epilepsy syndromes and etiologies.
- Further research is warranted to elucidate the mechanisms of response and non-response, and to refine treatment protocols.
Abstract:
There are limited treatment options for drug-resistant epilepsy (DRE) in children. We performed a pilot study to investigate the tolerability and effectiveness of cathodal transcranial direct current stimulation (tDCS) in DRE. Twelve children with DRE of varied etiology underwent three to four daily sessions of cathodal tDCS. The seizure frequency at 2 weeks before and after tDCS was obtained from seizure diaries; clinic reviews at 3 and 6 months assessed any longer-term benefits or adverse effects. The spike wave index (SWI) was analyzed in the EEGs done immediately before and after tDCS on the first and last day of tDCS. One child remained seizure free for a year after tDCS. One child had reduced frequency of ICU admissions for status epilepticus for 2 weeks, likely due to reduced severity of seizures. In four children, an improvement in alertness and mood was reported for 2-4 weeks after tDCS. There was no benefit following tDCS in the other children. There were no unexpected or serious adverse effects in any child. Benefit was seen in two children, and the reasons for the lack of benefit in the other children need further study. It is likely that tDCS stimulus parameters will need to be tailored for different epilepsy syndromes and etiologies.
