Transcranial magnetic stimulation as a feasible, non-invasive, neuromodulatory intervention in fetal alcohol spectrum disorders. A very first proof of concept.

Autor: Melder A; Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany., Wittmann E; Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany., Bulubas L; Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany; Center for Non-invasive Brain Stimulation Munich-Augsburg (CNBS(MA)), Germany., Dornheim B; Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany; Center for Non-invasive Brain Stimulation Munich-Augsburg (CNBS(MA)), Germany., Kerber K; Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany., Vogelmann U; Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany; Center for Non-invasive Brain Stimulation Munich-Augsburg (CNBS(MA)), Germany., Campana M; Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany; Center for Non-invasive Brain Stimulation Munich-Augsburg (CNBS(MA)), Germany., Hubert J; Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany., Schmidt V; Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany., Heinen F; Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany., Padberg F; Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany; Center for Non-invasive Brain Stimulation Munich-Augsburg (CNBS(MA)), Germany., Landgraf MN; Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany. Electronic address: mirjam.landgraf@med.uni-muenchen.de.
Jazyk: angličtina
Zdroj: European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society [Eur J Paediatr Neurol] 2023 Nov; Vol. 47, pp. 131-142. Date of Electronic Publication: 2023 Oct 24.
DOI: 10.1016/j.ejpn.2023.10.004
Abstrakt: Introduction: A neurobiological feature of Fetal Alcohol Spectrum Disorder (FASD) is a global decrease in neuronal connectivity, which leads to significant impairments in everyday functionality. Non-invasive repetitive transcranial magnetic stimulation (rTMS) could potentially positively influence neuronal plasticity but has not yet been studied in FASD. The present trial addresses this gap, making it the first-ever study of rTMS in FASD.
Materials and Methods: The prospective clinical trial was conducted at the LMU University Hospital Munich and enrolled eight FASD participants aged 6-16. Six sessions of 1 Hz-rTMS over the left dorsolateral prefrontal cortex were administered two times a week for three weeks consisting of 1500 pulses at 90 % of resting motor threshold in four trains of 375s. Outcome measures investigated feasibility and treatment response of rTMS on executive functions, attention/impulsivity, social-emotional regulation and quality of life (QoL) via standardized tests and the FASD parents' app.
Results: Adherence and retention rate were 100 %. Adverse events (AEs) were mild and self-limiting, resulting in a per-session risk of 53.3 %, with local paraesthesia accounting for 54.2 % of the AEs. There were individual relevant but no significant group-level improvements in the investigated functional cerebral domains or participants' QoL. The FASD parents' app showed no significant change in participants' daily functioning or caregivers' QoL. Caregivers' parental stress decreased significantly.
Conclusion: FASD is a very complex disorder that is difficult to treat. In addition, comorbidities as atypical responses to pharmacotherapies are frequent. For this reason, non-invasive, innovative therapies for children with FASD have to be developed. For the first time, rTMS was shown to be safe, tolerable, and acceptable and thus well feasible in paediatric patients with FASD. Further clinical studies with larger samples are needed to identify effective stimulation protocols and to evaluate treatment response.
Competing Interests: Declaration of competing interest The authors declare no conflict of interest.
(© 2023 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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