Transcranial Direct Current Stimulation in Pediatric Motor Disorders: A Systematic Review and Meta-analysis

Abstract

Objective: To systematically examine the safety and effectiveness of transcranial direct current stimulation (tDCS) interventions in pediatric motor disorders.

Data sources: PubMed, EMBASE, Cochrane, CINAHL, Web of Science, and ProQuest databases were searched from inception to August 2018.

Study selection: tDCS randomized controlled trials (RCTs), observational studies, conference proceedings, and dissertations in pediatric motor disorders were included. Two authors independently screened articles based on predefined inclusion criteria.

Data extraction: Data related to participant demographics, intervention, and outcomes were extracted by 2 authors. Quality assessment was independently performed by 2 authors.

Data synthesis: A total of 23 studies involving a total of 391 participants were included. There was no difference in dropout rates between active (1 of 144) and sham (1 of 144) tDCS groups, risk difference 0.0, 95% confidence interval (-.05 to .04). Across studies, the most common adverse effects in the active group were tingling (17.2%), discomfort (8.02%), itching (6.79%), and skin redness (4%). Across 3 studies in children with cerebral palsy, tDCS significantly improved gait velocity (MD=.23; 95% confidence interval [0.13-0.34]; P<.0005), stride length (MD=0.10; 95% confidence interval [0.05-0.15]; P<.0005), and cadence (MD=15.7; 95% confidence interval [9.72-21.68]; P<.0005). Mixed effects were found on balance, upper extremity function, and overflow movements in dystonia.

Conclusion: Based on the studies reviewed, tDCS is a safe technique in pediatric motor disorders and may improve some gait measures and involuntary movements. Research to date in pediatric motor disorders shows limited effectiveness in improving balance and upper extremity function. tDCS may serve as a potential adjunct to pediatric rehabilitation; to better understand if tDCS is beneficial for pediatric motor disorders, more well-designed RCTs are needed.

Keywords: Children; Motor disorders; Rehabilitation; Review; Transcranial direct current stimulation.

Conflict of interest statement

Conflicts of Interest: The authors declare no conflict of interest.

Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.

PRISMA flow-chart of study selection

Figure 2.

Forest plot of dropouts in tDCS trials. The diamond at the bottom of the plot summarizes the best estimate results of the meta-analysis with the width representing the corresponding 95% CI.

Figure 3.

Forest plot showing the effect sizes from the comparison between active vs. sham tDCS for spatiotemporal gait variables immediately post-tDCS from the Inverse-variance random effects model in children with cerebral palsy.

Figure 4.

Forest plot showing the effect sizes from the comparison between active vs. sham tDCS for Cadence, immediately post-tDCS and at 1-month follow-up, from the Inverse-variance random effects model in children with cerebral palsy.

Figure 5.

Forest plot showing the effect sizes from the comparison between active vs. sham tDCS for spatiotemporal gait variables at 1-month follow-up, from the Inverse-variance random effects model in children with cerebral palsy.

Figure 6.

Forest plot showing the effect sizes from the comparison between active vs. sham tDCS for anterior-posterior (AP) and medio-lateral (ML) sway in eyes open (EO) and eyes closed (EC) conditions from the Inverse-variance random effects model in children with cerebral palsy.

Figure 7.

Forest plot showing the effect sizes from the comparison between active vs. sham tDCS for the Assisting Hand Assessment, 1-week post-tDCS, from the Inverse-variance random effects model in children with cerebral palsy.

Figure 8.

Forest plot showing the effect sizes from the comparison between active vs. sham tDCS for the Gross Motor Function Measure for the standing (GMFM-D) and walking (GMFM-E) domains from the Inverse-variance random effects model in children with cerebral palsy.

Figure 9.

Forest plot showing the effect sizes from the comparison between active vs. sham tDCS for the Pediatric Balance Scale, immediately post-tDCS and at 1-month follow-up, from the Inverse-variance random effects model in children with cerebral palsy.

Figure 10.

Forest plot showing the effect sizes from the comparison between active vs. sham tDCS for the Pediatric Evaluation of Disability for the mobility and self-care domains, immediately post-tDCS and at 1-month follow-up, from the Inverse-variance random effects model in children with cerebral palsy.