Allen Corey H, Kluger Benzi M, Buard Isabelle
Neuroscience Institute, Georgia State University, Atlanta, Georgia.
Department of Neurology, University of Colorado-Anschutz Medical Campus, Aurora, Colorado.
Pediatr Neurol. 2017 Mar;68:3-17. doi: 10.1016/j.pediatrneurol.2016.12.009. Epub 2017 Jan 4.
Data and best practice recommendations for transcranial magnetic stimulation (TMS) use in adults are largely available. Although there are fewer data in pediatric populations and no published guidelines, its practice in children continues to grow.
We performed a literature search through PubMed to review all TMS studies from 1985 to 2016 involving children and documented any adverse events. Crude risks were calculated per session.
Following data screening we identified 42 single-pulse and/or paired-pulse TMS studies involving 639 healthy children, 482 children with central nervous system disorders, and 84 children with epilepsy. Adverse events occurred at rates of 3.42%, 5.97%, and 4.55% respective to population and number of sessions. We also report 23 repetitive TMS studies involving 230 central nervous system and 24 children with epilepsy with adverse event rates of 3.78% and 0.0%, respectively. We finally identified three theta-burst stimulation studies involving 90 healthy children, 40 children with central nervous system disorder, and no epileptic children, with adverse event rates of 9.78% and 10.11%, respectively. Three seizures were found to have occurred in central nervous system disorder individuals during repetitive TMS, with a risk of 0.14% per session. There was no significant difference in frequency of adverse events by group (P = 0.988) or modality (P = 0.928).
Available data suggest that risk from TMS/theta-burst stimulation in children is similar to adults. We recommend that TMS users in this population follow the most recent adult safety guidelines until sufficient data are available for pediatric specific guidelines. We also encourage continued surveillance through surveys and assessments on a session basis.
关于成人经颅磁刺激（TMS）应用的数据和最佳实践建议大多已可得。尽管儿科人群的数据较少且尚无已发表的指南，但其在儿童中的应用仍在不断增加。
我们通过PubMed进行文献检索，以回顾1985年至2016年所有涉及儿童的TMS研究，并记录任何不良事件。计算每次治疗的粗略风险。
经过数据筛选，我们确定了42项单脉冲和/或双脉冲TMS研究，涉及639名健康儿童、482名中枢神经系统疾病儿童和84名癫痫儿童。不良事件发生率分别为3.42%、5.97%和4.55%，与人群和治疗次数有关。我们还报告了23项重复TMS研究，涉及230名中枢神经系统疾病儿童和24名癫痫儿童，不良事件发生率分别为3.78%和0.0%。我们最终确定了3项theta爆发刺激研究，涉及90名健康儿童、40名中枢神经系统疾病儿童且无癫痫儿童，不良事件发生率分别为9.78%和10.11%。在重复TMS期间，中枢神经系统疾病个体中发现3例癫痫发作，每次治疗的风险为0.14%。各组不良事件发生频率（P = 0.988）或治疗方式（P = 0.928）无显著差异。
现有数据表明，儿童TMS/theta爆发刺激的风险与成人相似。我们建议该人群中的TMS使用者遵循最新的成人安全指南，直到有足够的数据用于制定儿科特定指南。我们还鼓励通过每次治疗的调查和评估持续进行监测。
