Transcranial Magnetic Stimulation in Children and Adolescents: A Review

Repetitive Transcranial Magnetic Stimulation (rTMS) has been approved for major depressive disorder in adolescents. We review evidence of the use of repetitive rTMS for Attention-Deficit, Hyperactivity Disorder (ADHD), autism spectrum disorder (ASD), schizophrenia, Tourette’s syndrome, depression, bipolar disorder, impulsivity, and borderline personality disorder (BPD) in adolescents. rTMS improves behavior and global functioning and reduces symptom severity in ADHD. Combined with atomoxetine, it improved attention, hyperactivity, and overall functioning. For ASD, rTMS decreased irritability, repetitive behaviors, and aggression. For schizophrenia, rTMS decreased auditory hallucinations and improved both positive and negative symptoms, agitation, and overall functioning. For Tourette’s Syndrome, rTMS reduced tic and obsessive-compulsive disorder symptoms and overall illness severity. rTMS reduces depressive symptoms. Some studies showed improvement in suicidal ideation following rTMS treatment, while others showed no difference from sham. Combining rTMS with sertraline improved mood and cognitive function. Bipolar depression and bipolar mania did not improve with rTMS. A study for bipolar II reported improvement in depressive symptoms and executive function following intermittent theta burst stimulation. rTMS reduced impulsive decision-making in healthy controls. For borderline personality disorder, a case study showed short-term improvements in depression, impulsivity, and emotional regulation. Two randomized controlled trials (RCTs) showed improvements in affective instability, anger, and planning, along with reductions in symptom severity, impulsivity, depression, and anxiety, respectively, following rTMS. Preliminarily, current evidence supports rTMS as a promising treatment modality.