Safety of Transcranial Magnetic Stimulation in Children: A Systematic Review of the Literature

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: adverse; neurostimulation; pediatric; seizure; transcranial.

Figure 1

Number of publications each year focusing on sp/ppTMS (dark gray), rTMS (black) and TBS (light gray).

Figure 2

Flow chart using the PRISMA statement for the systematic review.

Figure 3

Frequencies per grade of adverse event, per modality, and per population. Circle size is representative of AE frequency per session for sp/ppTMS (dark gray), rTMS (black) and TBS (light gray).