Jônatas Magalhães Santos, Lívia Vita Rodrigues, Pedro Henrique Rodrigues da Silva, Lais Boralli Razza, Paul E Croarkin, Andre Russowsky Brunoni
{"title":"经颅磁刺激和经颅直流电刺激治疗儿童和青少年精神疾病：临床试验荟萃分析综述","authors":"Jônatas Magalhães Santos, Lívia Vita Rodrigues, Pedro Henrique Rodrigues da Silva, Lais Boralli Razza, Paul E Croarkin, Andre Russowsky Brunoni","doi":"10.47626/1516-4446-2025-4219","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Non-invasive brain stimulation (NIBS), including 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 is to evaluate the efficacy and safety of NIBS in treating psychiatric disorders in children and adolescents.</p><p><strong>Methods: </strong>An umbrella review with a pre-registered PROSPERO protocol (CRD42023477743) was conducted. Meta-analyses were identified using MeSH-based searches in Embase, PubMed, PsycINFO, and Cochrane up to October 30th, 2023. PICO strategy guided study selection. Study quality was assessed using AMSTAR-2, and evidence certainty was rated with GRADE-pro.</p><p><strong>Results: </strong>Of 757 records screened, five meta-analyses, including 49 clinical trials and 2105 participants after excluding overlaped samples met inclusion criteria: four evaluating rTMS for depression and one assessing tDCS for ADHD. Among the four meta-analyses evaluating rTMS for depression, three had similar PICO criteria, and we prioritized the most recent with the largest number of trials and patients (Cao et al.) for formal evaluation. Cao et al. (low quality) reported significant improvement in depressive symptoms two (MD=4.68/GRADE=low) and four (MD=5.53/GRADE=low) weeks post-rTMS, with a positive response rate (OR=3.99/GRADE=very low) and minimal adverse effects. Sun et al. (critically low quality) found significant symptom improvement in first-episode depression using 10 Hz stimulation on L-DLPFC (SMD=1.63/GRADE=low), 1 Hz stimulation on R-DLPFC (SMD=1.22/GRADE=high), and remission rates (RR=1.35/GRADE=moderate). Furthermore, the discontinuation rate was low, without serious adverse events related. Brauer et al. (low quality) reported symptom improvement in ADHD with tDCS (SMD=0.363/GRADE=very low).</p><p><strong>Conclusion: </strong>NIBS appears safe and effective to treat psychiatric disorders in children and adolescents but requires further high-quality RCTs for clinical validation.</p>","PeriodicalId":520767,"journal":{"name":"Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Transcranial magnetic stimulation and transcranial direct current stimulation in psychiatric disorders in children and adolescents: an umbrella review of meta-analyses of clinical trials.\",\"authors\":\"Jônatas Magalhães Santos, Lívia Vita Rodrigues, Pedro Henrique Rodrigues da Silva, Lais Boralli Razza, Paul E Croarkin, Andre Russowsky Brunoni\",\"doi\":\"10.47626/1516-4446-2025-4219\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Non-invasive brain stimulation (NIBS), including 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 is to evaluate the efficacy and safety of NIBS in treating psychiatric disorders in children and adolescents.</p><p><strong>Methods: </strong>An umbrella review with a pre-registered PROSPERO protocol (CRD42023477743) was conducted. Meta-analyses were identified using MeSH-based searches in Embase, PubMed, PsycINFO, and Cochrane up to October 30th, 2023. PICO strategy guided study selection. Study quality was assessed using AMSTAR-2, and evidence certainty was rated with GRADE-pro.</p><p><strong>Results: </strong>Of 757 records screened, five meta-analyses, including 49 clinical trials and 2105 participants after excluding overlaped samples met inclusion criteria: four evaluating rTMS for depression and one assessing tDCS for ADHD. Among the four meta-analyses evaluating rTMS for depression, three had similar PICO criteria, and we prioritized the most recent with the largest number of trials and patients (Cao et al.) for formal evaluation. Cao et al. (low quality) reported significant improvement in depressive symptoms two (MD=4.68/GRADE=low) and four (MD=5.53/GRADE=low) weeks post-rTMS, with a positive response rate (OR=3.99/GRADE=very low) and minimal adverse effects. Sun et al. (critically low quality) found significant symptom improvement in first-episode depression using 10 Hz stimulation on L-DLPFC (SMD=1.63/GRADE=low), 1 Hz stimulation on R-DLPFC (SMD=1.22/GRADE=high), and remission rates (RR=1.35/GRADE=moderate). Furthermore, the discontinuation rate was low, without serious adverse events related. Brauer et al. 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Transcranial magnetic stimulation and transcranial direct current stimulation in psychiatric disorders in children and adolescents: an umbrella review of meta-analyses of clinical trials.
Objective: Non-invasive brain stimulation (NIBS), including 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 is to evaluate the efficacy and safety of NIBS in treating psychiatric disorders in children and adolescents.
Methods: An umbrella review with a pre-registered PROSPERO protocol (CRD42023477743) was conducted. Meta-analyses were identified using MeSH-based searches in Embase, PubMed, PsycINFO, and Cochrane up to October 30th, 2023. PICO strategy guided study selection. Study quality was assessed using AMSTAR-2, and evidence certainty was rated with GRADE-pro.
Results: Of 757 records screened, five meta-analyses, including 49 clinical trials and 2105 participants after excluding overlaped samples met inclusion criteria: four evaluating rTMS for depression and one assessing tDCS for ADHD. Among the four meta-analyses evaluating rTMS for depression, three had similar PICO criteria, and we prioritized the most recent with the largest number of trials and patients (Cao et al.) for formal evaluation. Cao et al. (low quality) reported significant improvement in depressive symptoms two (MD=4.68/GRADE=low) and four (MD=5.53/GRADE=low) weeks post-rTMS, with a positive response rate (OR=3.99/GRADE=very low) and minimal adverse effects. Sun et al. (critically low quality) found significant symptom improvement in first-episode depression using 10 Hz stimulation on L-DLPFC (SMD=1.63/GRADE=low), 1 Hz stimulation on R-DLPFC (SMD=1.22/GRADE=high), and remission rates (RR=1.35/GRADE=moderate). Furthermore, the discontinuation rate was low, without serious adverse events related. Brauer et al. (low quality) reported symptom improvement in ADHD with tDCS (SMD=0.363/GRADE=very low).
Conclusion: NIBS appears safe and effective to treat psychiatric disorders in children and adolescents but requires further high-quality RCTs for clinical validation.
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