Emerging brain-based interventions for children and adolescents: Overview and clinical perspective

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Child and Adolescent Psychiatric Clinics of North America (Impact Factor: 2.6). 02/2005; 14(1):1-19, v. DOI: 10.1016/j.chc.2004.07.011
Source: PubMed


Electroencephalogram biofeedback (EBF), repetitive transcranial magnetic stimulation (rTMS), and vagal nerve stimulation (VNS) are emerging interventions that attempt to directly impact brain function through neurostimulation and neurofeedback mechanisms. This article provides a brief overview of each of these techniques, summarizes the relevant research findings, and examines the implications of this research for practice standards based on the guidelines for recommending evidence based treatments as developed by the American Academy of Child and Adolescent Psychiatry for attention deficit hyperactivity disorder (ADHD). EBF meets the "Clinical Guidelines" standard for ADHD, seizure disorders, anxiety, depression, and traumatic brain injury. VNS meets this same standard for treatment of refractory epilepsy and meets the lower "Options" standard for several other disorders. rTMS meets the standard for "Clinical Guidelines" for bipolar disorder, unipolar disorder, and schizophrenia. Several conditions are discussed regarding the use of evidence based thinking related to these emerging interventions and future directions.

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    • "Likewise, changes in fMRI activation after EEG neurofeedback have been shown in targeted neural networks after a single 30-minute EEG training session (Ros et al., 2013) and in a specific symptom-related brain region of interest (ROI) after multiple training sessions (Levesque et al., 2006). There have been multiple randomized controlled trials (RCTs) using EEG-based feedback, primarily in patients with attention deficit hyperactivity disorder (ADHD) (Hirshberg et al., 2005). A recent meta-analysis of existing RCTs indicates that EEG feedback training is associated with a reduction of ADHD symptoms with a large effect size (Arns et al., 2009) and a large randomized, sham-controlled trial is currently underway (LH, personal communication). "
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    • "There are no controlled trials conducted on the efficacy of rTMS for treatment of any disorder in children and adolescents. However, there are case reports of improvement with rTMS in bipolar disorder, unipolar depression, schizophrenia and seizure disorders such as epilepsia partialis continua, action myoclonus and progressive myoclonic epilepsy.[65] In attention deficit/hyperactivity disorder (ADHD), there is a dysfunction in dopamine neuronal circuitry and rTMS has been suggested as a treatment modality that requires further investigation.[66] "
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    ABSTRACT: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and relatively painless tool that has been used to study various cognitive functions as well as to understand the brain-behavior relationship in normal individuals as well as in those with various neuropsychiatric disorders. It has also been used as a therapeutic tool in various neuropsychiatric disorders because of its ability to specifically modulate distinct brain areas. Studies have shown that repeated stimulation at low frequency produces long-lasting inhibition, which is called as long-term depression, whereas repeated high-frequency stimulation can produce excitation through long-term potentiation. This paper reviews the current status of rTMS as an investigative and therapeutic modality in various neuropsychiatric disorders. It has been used to study the cortical and subcortical functions, neural plasticity and brain mapping in normal individuals and in various neuropsychiatric disorders. rTMS has been most promising in the treatment of depression, with an overall milder adverse effect profile compared with electroconvulsive therapy. In other neuropsychiatric disorders such as schizophrenia, mania, epilepsy and substance abuse, it has been found to be useful, although further studies are required to establish therapeutic efficacy. It appears to be ineffective in the treatment of obsessive compulsive disorder. There is a paucity of studies of efficacy and safety of rTMS in pediatric and geriatric population. Although it appears safe, further research is required to optimize its efficacy and reduce the side-effects. Magnetic seizure therapy, which involves producing seizures akin to electroconvulsive therapy, appears to be of comparable efficacy in the treatment of depression with less cognitive adverse effects.
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    • "One approach in this regard is plasticity-inducing rehabilitation training (PIRT), which utilizes neurofeedback training of EEG signals as a form of operant conditioning (Lubar 1997). This type of training has been used clinically for many years and provides real-time feedback to the user allowing for alteration and enhancement of brain function (Hirshberg et al., 2005). One explanation of how such training produces its behavioral and electrophysiological effects is by gaining access to and control over regulatory mechanisms that increase or decrease synchronous or desynchronous activity in thalamocortical networks (Lilienfeld, 2005). "

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