Dosage considerations for transcranial direct current stimulation in children: a computational modeling study
Transcranial direct current stimulation (tDCS) is being widely investigated in adults as a therapeutic modality for brain disorders involving abnormal cortical excitability or disordered network activity. Interest is also growing in studying tDCS in children. Limited empirical studies in children su...
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| description | Transcranial direct current stimulation (tDCS) is being widely investigated in adults as a therapeutic modality for brain disorders involving abnormal cortical excitability or disordered network activity. Interest is also growing in studying tDCS in children. Limited empirical studies in children suggest that tDCS is well tolerated and may have a similar safety profile as in adults. However, in electrotherapy as in pharmacotherapy, dose selection in children requires special attention, and simple extrapolation from adult studies may be inadequate. Critical aspects of dose adjustment include 1) differences in neurophysiology and disease, and 2) variation in brain electric fields for a specified dose due to gross anatomical differences between children and adults. In this study, we used high-resolution MRI derived finite element modeling simulations of two healthy children, ages 8 years and 12 years, and three healthy adults with varying head size to compare differences in electric field intensity and distribution. Multiple conventional and high-definition tDCS montages were tested. Our results suggest that on average, children will be exposed to higher peak electrical fields for a given applied current intensity than adults, but there is likely to be overlap between adults with smaller head size and children. In addition, exposure is montage specific. Variations in peak electrical fields were seen between the two pediatric models, despite comparable head size, suggesting that the relationship between neuroanatomic factors and bioavailable current dose is not trivial. In conclusion, caution is advised in using higher tDCS doses in children until 1) further modeling studies in a larger group shed light on the range of exposure possible by applied dose and age and 2) further studies correlate bioavailable dose estimates from modeling studies with empirically tested physiologic effects, such as modulation of motor evoked potentials after stimulation. |
| doi_str_mv | 10.1371/journal.pone.0076112 |
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Our results suggest that on average, children will be exposed to higher peak electrical fields for a given applied current intensity than adults, but there is likely to be overlap between adults with smaller head size and children. In addition, exposure is montage specific. Variations in peak electrical fields were seen between the two pediatric models, despite comparable head size, suggesting that the relationship between neuroanatomic factors and bioavailable current dose is not trivial. In conclusion, caution is advised in using higher tDCS doses in children until 1) further modeling studies in a larger group shed light on the range of exposure possible by applied dose and age and 2) further studies correlate bioavailable dose estimates from modeling studies with empirically tested physiologic effects, such as modulation of motor evoked potentials after stimulation.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0076112</identifier><identifier>PMID: 24086698</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adults ; Age Factors ; Anatomy ; Bioavailability ; Brain ; Brain - anatomy & histology ; Brain - physiology ; Brain architecture ; Child ; Children ; Computational Biology - methods ; Computational neuroscience ; Computer applications ; Computer Simulation ; Correlation analysis ; Cortex ; Direct current ; Drug dosages ; Electric currents ; Electric fields ; Electric power distribution ; Electric Stimulation Therapy - methods ; Electrical stimulation of the brain ; Electrodes ; Epilepsy ; ESB ; Excitability ; Exposure ; Finite Element Analysis ; Finite element method ; Head ; Humans ; Magnetic Resonance Imaging ; Mathematical models ; Medicine ; Models, Neurological ; Motor evoked potentials ; Neurophysiology ; Neurosciences ; NMR ; Nuclear magnetic resonance ; Pediatrics ; Pharmacology ; Scanners ; Skin ; Stimulation ; Studies</subject><ispartof>PloS one, 2013-09, Vol.8 (9), p.e76112-e76112</ispartof><rights>2013 Kessler et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kessler, Sudha Kilaru</au><au>Minhas, Preet</au><au>Woods, Adam J</au><au>Rosen, Alyssa</au><au>Gorman, Casey</au><au>Bikson, Marom</au><au>Chambers, Chris</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dosage considerations for transcranial direct current stimulation in children: a computational modeling study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2013-09-27</date><risdate>2013</risdate><volume>8</volume><issue>9</issue><spage>e76112</spage><epage>e76112</epage><pages>e76112-e76112</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Transcranial direct current stimulation (tDCS) is being widely investigated in adults as a therapeutic modality for brain disorders involving abnormal cortical excitability or disordered network activity. Interest is also growing in studying tDCS in children. Limited empirical studies in children suggest that tDCS is well tolerated and may have a similar safety profile as in adults. However, in electrotherapy as in pharmacotherapy, dose selection in children requires special attention, and simple extrapolation from adult studies may be inadequate. Critical aspects of dose adjustment include 1) differences in neurophysiology and disease, and 2) variation in brain electric fields for a specified dose due to gross anatomical differences between children and adults. In this study, we used high-resolution MRI derived finite element modeling simulations of two healthy children, ages 8 years and 12 years, and three healthy adults with varying head size to compare differences in electric field intensity and distribution. Multiple conventional and high-definition tDCS montages were tested. Our results suggest that on average, children will be exposed to higher peak electrical fields for a given applied current intensity than adults, but there is likely to be overlap between adults with smaller head size and children. In addition, exposure is montage specific. Variations in peak electrical fields were seen between the two pediatric models, despite comparable head size, suggesting that the relationship between neuroanatomic factors and bioavailable current dose is not trivial. In conclusion, caution is advised in using higher tDCS doses in children until 1) further modeling studies in a larger group shed light on the range of exposure possible by applied dose and age and 2) further studies correlate bioavailable dose estimates from modeling studies with empirically tested physiologic effects, such as modulation of motor evoked potentials after stimulation.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24086698</pmid><doi>10.1371/journal.pone.0076112</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adults Age Factors Anatomy Bioavailability Brain Brain - anatomy & histology Brain - physiology Brain architecture Child Children Computational Biology - methods Computational neuroscience Computer applications Computer Simulation Correlation analysis Cortex Direct current Drug dosages Electric currents Electric fields Electric power distribution Electric Stimulation Therapy - methods Electrical stimulation of the brain Electrodes Epilepsy ESB Excitability Exposure Finite Element Analysis Finite element method Head Humans Magnetic Resonance Imaging Mathematical models Medicine Models, Neurological Motor evoked potentials Neurophysiology Neurosciences NMR Nuclear magnetic resonance Pediatrics Pharmacology Scanners Skin Stimulation Studies |
| title | Dosage considerations for transcranial direct current stimulation in children: a computational modeling study |
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