RESUMEN
BACKGROUND: Non-invasive brain stimulation is being increasingly used to interrogate neurophysiology and modulate brain function. Despite the high scientific and therapeutic potential of non-invasive brain stimulation, experience in the developing brain has been limited. OBJECTIVE: To determine the safety and tolerability of non-invasive neurostimulation in children across diverse modalities of stimulation and pediatric populations. METHODS: A non-invasive brain stimulation program was established in 2008 at our pediatric, academic institution. Multi-disciplinary neurophysiological studies included single- and paired-pulse Transcranial Magnetic Stimulation (TMS) methods. Motor mapping employed robotic TMS. Interventional trials included repetitive TMS (rTMS) and transcranial direct current stimulation (tDCS). Standardized safety and tolerability measures were completed prospectively by all participants. RESULTS: Over 10 years, 384 children underwent brain stimulation (median 13 years, range 0.8-18.0). Populations included typical development (n = 118), perinatal stroke/cerebral palsy (n = 101), mild traumatic brain injury (n = 121) neuropsychiatric disorders (n = 37), and other (n = 7). No serious adverse events occurred. Drop-outs were rare (<1%). No seizures were reported despite >100 participants having brain injuries and/or epilepsy. Tolerability between single and paired-pulse TMS (542340 stimulations) and rTMS (3.0 million stimulations) was comparable and favourable. TMS-related headache was more common in perinatal stroke (40%) than healthy participants (13%) but was mild and self-limiting. Tolerability improved over time with side-effect frequency decreasing by >50%. Robotic TMS motor mapping was well-tolerated though neck pain was more common than with manual TMS (33% vs 3%). Across 612 tDCS sessions including 92 children, tolerability was favourable with mild itching/tingling reported in 37%. CONCLUSIONS: Standard non-invasive brain stimulation paradigms are safe and well-tolerated in children and should be considered minimal risk. Advancement of applications in the developing brain are warranted. A new and improved pediatric NIBS safety and tolerability form is included.
Asunto(s)
Conmoción Encefálica/terapia , Epilepsia/terapia , Accidente Cerebrovascular/terapia , Estimulación Transcraneal de Corriente Directa/métodos , Estimulación Magnética Transcraneal/métodos , Niño , Femenino , Cefalea/etiología , Humanos , Masculino , Prurito/etiología , Convulsiones/etiología , Estimulación Transcraneal de Corriente Directa/efectos adversos , Estimulación Magnética Transcraneal/efectos adversosRESUMEN
To determine the effects of case management in controlling hospital based costs for persons with AIDS (PWAs), a retrospective review of records of deceased PWAs was performed. The study compared diagnosis-to-death hospital charges for PWAs who received care under a care management model (n = 60) with PWAs receiving care within a non-case managed approach (n = 60). Hospital charges were adjusted for inflation. PWAs receiving care within the case managed model had significantly lower hospital-based changes than the non-case managed group. Additionally, PWAs in the case managed group lived significantly longer between HIV diagnosis and death, and lived longer between their first AIDS-related hospital admission and death.