title: Safety of noninvasive brain stimulation in children and adolescents.
abstract: BACKGROUND
  Noninvasive brain stimulation (NIBS) techniques such as transcranial magnetic stimulation (TMS) and transcranial current stimulation (tCS) have the potential to mitigate a variety of symptoms associated with neurological and psychiatric conditions, including stroke, cerebral palsy, autism, depression, and Tourette syndrome. While the safety of these modalities has been established in adults, there is a paucity of research assessing the safety of NIBS among children.
  
  
  OBJECTIVE
  To examine the existing literature regarding the safety of NIBS techniques in children and adolescents with neurologic and neuropsychiatric disorders.
  
  
  METHODS
  An electronic search was performed on online databases for studies using NIBS in individuals less than 18 years of age. Non-English publications, diagnostic studies, electroconvulsive therapy, single/dual pulse TMS studies, and reviews were excluded. Adverse events reported in the studies were carefully examined and synthesized to understand the safety and tolerability of NIBS among children and adolescents.
  
  
  RESULTS
  The data from 48 studies involving more than 513 children/adolescents (2.5-17.8 years of age) indicate that the side effects of NIBS were, in general, mild and transient [TMS: headache (11.5%), scalp discomfort (2.5%), twitching (1.2%), mood changes (1.2%), fatigue (0.9%), tinnitus (0.6%); tCS: tingling (11.5%), itching (5.8%), redness (4.7%), scalp discomfort (3.1%)] with relatively few serious adverse events.
  
  
  CONCLUSIONS
  Our findings indicate that both repetitive TMS and tCS are safe modalities in children and adolescents with various neurological conditions, especially when safety guidelines are followed. The incidence of adverse events appears to be similar to that observed in adults; however, further studies with longer treatment and follow-up periods are needed to better understand the benefits and tolerance of long-term use of NIBS in children.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: mouli@umich.edu.
authors.forename: Chandramouli
authors.initials: C
authors.lastname: Krishnan
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Luciana
authors.initials: L
authors.lastname: Santos
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Peterson
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Ehinger
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001921:Brain / Q000502:physiology*; D002648:Child; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D009422:Nervous System Diseases / Q000628:therapy*; D065908:Transcranial Direct Current Stimulation / Q000009:adverse effects*; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects*
keywords: Guidelines; Safety; TMS; Theta burst; Tolerability; tDCS