Transcranial Direct Current Stimulation (tDCS) in Children and Adolescents With Epilepsy and Depression

January 15, 2020 updated by: Paul E. Croarkin, Mayo Clinic

A Pilot Study of the Tolerability and Efficacy of Transcranial Direct Current Stimulation (tDCS) in Children and Adolescents With Epilepsy and Comorbid Depression

The proposed study seeks to obtain preliminary signal of the tolerability and efficacy of transcranial direct current stimulation (tDCS) for depressive symptoms in a sample of adolescents with depression and epilepsy. Additionally, effects of tDCS will be assessed via electroencephalographic, cognitive, and psychosocial measures.

Study Overview

Status

Withdrawn

Conditions

Intervention / Treatment

Detailed Description

Transcranial direct current stimulation (tDCS) has been investigated extensively in recent years for the treatment of depression. Meta-analysis of individual patient data indicates that tDCS results in improvement in depressive symptoms, with efficacy comparable to antidepressant medications and repetitive transcranial magnetic stimulation (rTMS), while tDCS offers advantages over other treatments, including side effect profile, cost, and portability. tDCS has been employed to a more limited extent in children and adolescents for psychiatric conditions other than depression, as well as in both adults and children with epilepsy, with excellent tolerability and a mild adverse effect profile. The proposed protocol aims to extend the use of tDCS for treatment of depression in children with epilepsy (CWE), a population with a very high prevalence of depression and a significant need for additional treatment options, particularly nonpharmacologic treatments, due to challenges with the use of antidepressant medications and other non-invasive brain stimulation (NIBS) techniques in CWE.

Study Type

Interventional

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Minnesota
      • Rochester, Minnesota, United States, 55905
        • Mayo Clinic

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

6 years to 17 years (Child, Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Diagnosis of generalized epilepsy (confirmed by neurologist)
  • Diagnosis of depressive disorder (confirmed by psychiatrist), with CDRS-R score ≥ 40
  • Parent/guardian ability to provide written informed consent in English, with child/adolescent participant able to provide assent (for participants <18 years of age), or participant ability to provide written informed consent in English (for participants ≥18 years of age)
  • Antidepressant medications (SSRI or SNRI) permitted, provided that no dosing change has occurred in two months prior to baseline assessments; antidepressant medication not required for enrollment
  • AED medications (with exceptions listed below in exclusion criteria) permitted, provided that no change in AED regimen has occurred in two months prior to baseline assessments (except for weight/growth-related dosing changes); AED not required for enrollment

Exclusion Criteria:

  • Presence of pacemaker or metallic implant (with the exception of orthodontic hardware)
  • Prior surgical intervention for epilepsy
  • More than one generalized tonic-clonic (GTC) seizure during two months prior to enrollment
  • AED regimen change during two months prior to baseline assessments (except dosing adjustments made strictly due to growth/weight change)
  • Antidepressant medication change during two months prior to baseline assessments
  • Lifetime history of manic/hypomanic episode or psychotic disorder
  • Autism spectrum disorder (ASD) diagnosis
  • Documented history of intellectual disability (documented full-scale IQ greater than two standard deviations below mean)
  • Current or recent (two months prior to baseline assessments) active substance use disorder
  • Imminent risk of suicide or medically serious self-injurious behavior (as evaluated by board-certified child and adolescent psychiatrist)
  • Current pregnancy or positive urine pregnancy test
  • Prohibited concomitant medications include: regularly scheduled benzodiazepines (except clobazam); barbiturates; neuroleptic/antipsychotic medications; lithium.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: transcranial direct current stimulation
Transcranial direct current stimulation (35 sq cm anode over left dorsolateral prefrontal cortex, 35 sq cm cathode over right supraorbital area, 1 mA current, 20 min per treatment session, 1 session per day, 10 treatment sessions over two weeks)
Device: transcranial direct current stimulation
The Soterix Medical 1×1 Low Intensity Transcranial DC Stimulator Model 1300A is an investigational device manufactured by Soterix Medical, Inc. (New York, NY, USA). It is designed for use in noninvasive transcranial stimulation of the brain by delivering low-intensity electrical current to the scalp through two electrodes.
Other Names:
  • Soterix Medical Model 1300A

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Children's Depression Rating Scale - Revised (CDRS-R) total score
Time Frame: 2 weeks
clinician-rated continuous measure of depression severity based on participant and parent interviews
2 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Children's Depression Rating Scale - Revised (CDRS-R) total score
Time Frame: 3 months, 6 months
clinician-rated continuous measure of depression severity based on participant and parent interviews
3 months, 6 months
Quick Inventory of Depressive Symptoms - Adolescent - Self-Report (QIDS-A17-SR) total score
Time Frame: day 1, day 5, day 10, 3 months, 6 months
participant-reported continuous measure of depression severity
day 1, day 5, day 10, 3 months, 6 months
tDCS Adverse Effects Survey
Time Frame: days 1-10, 2 weeks, 3 months, 6 months
standardized self-report questionnaire for active reporting of adverse effects; will be used to calculate incidence of all adverse effects (AEs) and severe adverse effects (SAEs) as well as incidence of specific AEs/SAEs
days 1-10, 2 weeks, 3 months, 6 months
Columbia Suicide Severity Rating Scale (C-SSRS)
Time Frame: day 1, day 5, day 10, 2 weeks, 3 months, 6 months
measure of suicidal ideation and behavior based on clinician interview
day 1, day 5, day 10, 2 weeks, 3 months, 6 months
Young Mania Rating Scale (YMRS)
Time Frame: day 5, 2 weeks
measure of manic symptoms based on clinician interview/observation
day 5, 2 weeks
Affective Reactivity Index (ARI)
Time Frame: 2 weeks, 3 months, 6 months
parent- and participant-report questionnaires regarding symptoms of irritability
2 weeks, 3 months, 6 months
Mayo Seizure Frequency Assessment
Time Frame: 2 weeks, 3 months, 6 months
parent- and participant-report questionnaires regarding seizure frequency
2 weeks, 3 months, 6 months
Liverpool Seizure Severity Scale (1998 revision)
Time Frame: 2 weeks, 3 months, 6 months
parent-/participant-report questionnaire regarding seizure severity and quality
2 weeks, 3 months, 6 months
Impact of Pediatric Epilepsy Scale (IPES)
Time Frame: 2 weeks, 3 months, 6 months
parent-report questionnaire regarding impact of epilepsy of quality of life
2 weeks, 3 months, 6 months
Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48)
Time Frame: 2 weeks, 3 months, 6 months
participant-report questionnaire regarding impact of epilepsy of quality of life
2 weeks, 3 months, 6 months
NIH Toolbox® for Assessment of Neurological and Behavioral Function
Time Frame: 2 weeks
validated and age-normed computer-administered battery of measures assessing cognitive functioning
2 weeks
Electroencephalography (EEG)
Time Frame: 2 weeks
objective electrophysiologic data on brain activity; a board-certified epileptologist will manually quantify the maximal number of spike-wave discharges per 20-second recording, the longest run of epileptiform discharges, and, if sleep EEG is obtained, the spike-wave index; additionally, broadband EEG will be obtained to assess indices of cortical excitability, such as relationships between slow oscillations, interictal epileptiform discharges, and sleep architecture
2 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Mayo Clinic

Investigators

  • Principal Investigator: Paul E Croarkin, DO, Mayo Clinic

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 23, 2018

Primary Completion (Anticipated)

January 1, 2019

Study Completion (Anticipated)

January 1, 2019

Study Registration Dates

First Submitted

December 1, 2017

First Submitted That Met QC Criteria

December 5, 2017

First Posted (Actual)

December 11, 2017

Study Record Updates

Last Update Posted (Actual)

January 18, 2020

Last Update Submitted That Met QC Criteria

January 15, 2020

Last Verified

January 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 17-001007

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

Yes

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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