Transcranial magnetic stimulation in child psychiatry

  Transcranial Magnetic Stimulation (TMS) is a new neurophysiological technique created by Barker et al. at the University of Sheffield in 1985, which has the advantages of uniqueness in function, non-invasive, painless, easy to operate, safe and reliable. TMS can be divided into three types: single pulse stimulation, double pulse stimulation and continuous pulse stimulation.  Currently, continuous pulse stimulation, or Repetitive Transcranial Magnetic Stimulation (rTMS), is the most commonly used technique. rTMS can have a functional effect on many parts of the cortex. rTMS can lead to a reduction in local cortical blood flow under the coil, which reflects a modulation of synaptic connectivity in this area. Activity modulation in this region. It can produce long-lasting plastic changes in the motor system. Different frequencies may have different effects on cortical metabolism: high frequency stimulation (15-25 Hz) may lead to increased local metabolic levels, while low frequency stimulation (1-5 Hz) may decrease local metabolic levels. Therefore, different frequencies need to be used to adjust for different functional conditions in the brain.  rTMS has been used in the treatment of various disorders such as psychological disorders and movement disorders. In psychiatry, the first and most used treatment for rTMS was depression, where the mechanism of action is to act on neural networks and have an effect on neurotransmitter systems, such as causing the release of striatal dopamine, modulating 5-hydroxytryptamine and glutamatergic neurotransmitters, and possibly affecting the activity of the hypothalamic-pituitary-adrenal axis. The U.S. FDA officially issued approval for TMS for clinical depression treatment in December 2008. Magnetic stimulation is already one of the basic clinical treatment methods for depression and has the advantages of being easier to operate than twitch-free electroconvulsive therapy, requiring no anesthesia, and easily accepted by patients in terms of methodology. The use of rTMS for the treatment of schizophrenia, obsessive-compulsive disorder, anxiety disorders, ADHD, autism, and Tourette’s syndrome has also been reported. Quintana (2005) reviewed the literature on the use of TMS for the treatment of children and adolescents under the age of 18 and noted that no significant side effects or seizures were seen in the use of rTMS for the treatment of children with psychiatric disorders. It was concluded that TMS is also safe for use in children and adolescents under the age of 18.  In an open study by Kwon et al. (2011) using 1HZ low-frequency rTMS to treat 10 male children aged 9-14 years with tic disorders (mean age 11.2 ± 2.0 years) in Korea, rTMS treatment of the supplementary motor area (SMA) for 10 days was found to reduce tic symptoms and the efficacy lasted for more than 12 weeks without significant side effects or exacerbation of hyperactivity (ADHD), depression, and anxiety symptoms.  Since the current pharmacological treatment in child psychiatry is sometimes not very satisfactory and pharmacological treatment may have different degrees of side effects, such as excessive sedation, drowsiness, extrapyramidal reactions, increased body mass, and liver function impairment, attempts to use noninvasive, nonpharmacological treatment with transcranial magnetic stimulation as a treatment option and rTMS as a new technique in child psychiatry may have a wide prospect of application.