Transcranial direct current stimulation in the modulation of neuropathic pain: a systematic review

Objective To investigate the neuromodulating effect of Transcranial Direct Current Stimulation (tDCS) on Neuropathic Pain (NP).

Method A systematic review of articles published in the past five years in MEDLINE, LILACS, Cochrane, Scopus, ScienceDirect, and PEDro. The search was carried out from February to May 2017 using the keywords: neuropathic pain, neuralgia, nerve pain, central pain, peripheral nerve pain, tDCS. The selected studies were full articles written in Portuguese, English, or Spanish with at least one control group, and no less than one pre- or post-intervention variable, with the exclusion of case studies or case series, animal model studies, and studies with combined therapy. The quality of the selected articles was evaluated through PEDro scale, whereas the level of agreement among reviewers was measured with the Cohen’s κ test, considering P < 0.05 to be significant.

Results Eight articles were selected (PEDro: 8.5 ± 0.6; Cohen’s κ test: 0.703, P < 0.01), six of which were randomized controlled trials and two were controlled clinical trials. The following causes of NP were observed: spinal cord injury (SCI), amputation, stroke, multiple sclerosis (MS), and radiculopathy. All of the studies showed significant effects of tDCS on NP when compared to the control group, except for one with SCI and another related to radiculopathy.

Discussion The shortage of good quality articles, the varying of ramp-on and ramp-off durations, and number of sessions, as well as the diversity of results found did not allow any definite conclusion on the efficacy of the neuromodulating effect of tDCS on NP.     

Toilet training interventions for children with autism spectrum disorder: A systematic review

BackgroundChildren on the autism spectrum can often reach independence in toileting at a later age than nonautistic children, which impacts their health outcomes, independence and social participation. This study aimed to systematically review evidence-based toilet training interventions for children on the autism spectrum, and assess the quality of existing evidence.MethodGuided by the PRISMA statement, a search of scholarly databases was conducted and the study characteristics, methodological quality and intervention components of included studies were examined.ResultsThis systematic review identified 26 studies that evaluated toilet training interventions for children on the autism spectrum. Results identified that while Azrin and Foxx’s (1971) Rapid Toilet Training approach is most widely researched for children on the autism spectrum, investigating the effects of current toilet training approaches is limited by small sample sizes, low-level study designs and variable methods of reporting outcomes.ConclusionGreater consideration of parent-child communication, children’s developmental and toileting skill level may facilitate development of toileting approaches that better meet the needs of children on the autism spectrum and their families.     

Transcranial direct current stimulation for auditory verbal hallucinations:a systematic review of clinical trials

Transcranial direct current stimulation(tDCS) has been reportedly beneficial for different neurodegenerative disorders. tDCS has been reported as a potential adjunctive or alternative treatment for auditory verbal hallucination(AVH). This study aims to review the effects of tDCS on AVH in patients with schizophrenia through combining the evidence from randomized clinical trials(RCTs). The databases of PsycINFO(2000–2019), PubMed(2000–2019), EMBASE(2000–2019), CINAHL(2000–2019), Web of Science(2000–2019), and Scopus(2000–2019) were systematically searched. The clinical trials with RCT design were selected for final analysis. A total of nine RCTs were eligible and included in the review. Nine RCTs were included in the final analysis. Among them, six RCTs reported a significant reduction of AVH after repeated sessions of tDCS, whereas three RCTs did not show any advantage of active tDCS over sham tDCS. The current studies showed an overall decrease of approximately 28% of AVH after active tDCS and 10% after sham tDCS. The tDCS protocols targeting the sensorimotor frontal-parietal network showed greater treatment effects compared with the protocols targeting other regions. In this regard, cathodal tDCS over the left temporoparietal area showed inhibitory effects on AVHs. The most effective tDCS protocol on AVHs was twice-daily sessions(2 mA, 20-minute duration) over 5 consecutive days(10 sessions) with the anode over the left dorsolateral prefrontal cortex and the cathode over the left temporal area. Some patient-specific and diseasespecific factors such as young age, nonsmoking status, and higher frequencies of AVHs seemed to be the predictors of treatment response. Taken together, the results of tDCS as an alternative treatment option for AVH show controversy among current literatures, since not all studies were positive. However, the studies targeting the same site of the brain showed that the tDCS could be a promising treatment option to reduce AVH. Further RCTs, with larger sample sizes, should be conducted to reach a conclusion on the efficacy of tDCS for AVH and to develop an effective therapeutic protocol for clinical setting.     

Transcranial direct current stimulation in disorders of consciousness: a review

It is a challenge to evaluate and treat the patients with disorders of consciousness (DOC) in the clinic. Due to the huge costs of prolonged intensive care, the management of these patients raises great financial strain on families and important ethical questions. To date, several studies have attempted to specifically detect pharmacologic or non-pharmacologic effectiveness, and until now, there are no evidence-based guidelines about the treatment of patients with DOC. Recently, because of ethical and procedural limitations on the use of invasive stimulation techniques, non-invasive brain stimulation, such as the transcranial direct current stimulation (tDCS), has been investigated for improving the level of consciousness in patients with DOC. This paper briefly reviewed the key clinical investigations using tDCS with the aim of better understanding the pathophysiological mechanism of DOC or improving the level of consciousness in patients with DOC. In conclusion, some beneficial results of tDCS protocols have been shown in patients with DOC, especially targeting the left dorsolateral prefrontal cortex in minimally conscious state. However, these investigations must be continued in larger controlled, randomized, blinded and prospective studies in order to transpose these preliminary data to clinical effects. Furthermore, an encouraging perspective for the future is the combination of neurophysiological or functional neuroimaging techniques with non-invasive brain stimulation to evaluate neuro-modulatory effects of stimulation in patients with DOC.     

A systematic review of peer-mediated interventions for children with autism spectrum disorder

BackgroundPeer mediated intervention (PMI) is a promising practice used to increase social skills in children with autism spectrum disorder (ASD). PMIs engage typically developing peers as social models to improve social initiations, responses, and interactions.MethodThe current study is a systematic review examining PMIs for children and adolescents with ASD conducted using group designs. Five studies met the pre-specified review inclusion criteria: four randomized controlled trials and one pre- and post-test design.ResultsFour of the studies were conducted in school settings, whereas one study was conducted in a camp setting. The studies all reported that participants improved in social skills (e.g., social initiations, social responses, social communication) post intervention. Additionally, sustainment, generalization, and fidelity of implementation were examined.ConclusionPMI is a promising approach to address social skills in children with ASD, and this approach can be conducted in meaningful real-word contexts, such as schools. Limitations of the studies as well as future directions are discussed.     

Transcranial direct current stimulation for post-stroke dysphagia: a systematic review and meta-analysis of randomized controlled trials

Journal of Neurology - Transcranial direct current stimulation (tDCS) has been investigated as a tool for dysphagia recovery after stroke in several single-center randomized controlled trials...     

The quality of life of parents of children with autism spectrum disorder: A systematic review

BackgroundPrevious research has raised concerns about the quality of life (QoL) of parents of children with autism spectrum disorder (ASD). A better understanding of parental QoL can inform clinicians and policymakers and lead to improved outcomes for both parents and children.AimsThis review aimed to systematically examine studies measuring the QoL among parents of children with ASD (<18 years) and to investigate its parental, child-related and contextual associated factors.MethodologyAn electronic database search was conducted using Medline, Psycinfo, Embase, CINAHL, Biosis, ASSIA, Social Services Abstracts, Sociological Abstracts and Open grey.ResultsThis review indicated poorer QoL among parents of children with ASD compared to parents of typically developing children or to population norms. Variables associated with lower parental QoL within this group included child behavioural difficulties, unemployment, being a mother and lack of social support.ConclusionThis review verified previous reports on lower QoL among parents of children with ASD and highlighted potential areas of support. Implications for future research, policy and practice are discussed.     

Transcranial direct current stimulation for hyperactivity and noncompliance in autistic disorder

Objectives. To evaluate the safety, efficacy, and feasibility of inhibitory transcranial direct current stimulation (tDCS) for the treatment of behavioural abnormalities of autistic patients. Methods. Twelve young adult patients with autistic disorder were enrolled. All subjects presented intellectual disability and most of them had speech impairment. The Aberrant Behavior Checklist (ABC) was administered as the primary outcome measure before and after a 2-week tDCS course. All subjects received 10 daily applications of 20 min/1.5 mA/cathodal (inhibitory) tDCS over the left dorso-lateral pre-frontal cortex. Results. Eight out of 10 study completers improved in their abnormal behaviours, reaching an average reduction of 26.7% of the total ABC score. The remaining two patients showed no changes. In the whole group of completers, among the five subscales contributing to the significant reduction of the total score, the most remarkable and statistically significant change was seen in the subscale assessing hyperactivity and non-compliance (–35.9%, P = 0.002). No adverse effects were reported. Conclusions. Inhibitory tDCS improved the ABC rating scores for autistic behaviours. Owing to its ease of use, cost-effectiveness and the limited availability of specific treatment strategies, tDCS might be a valid therapeutic option to be tested in autistic patients.     

Methodological considerations in the use of standardized motor assessment tools for children with autism spectrum disorder: A scoping review

BackgroundThis scoping review identified methodological parameters affecting evaluation when administering standardized motor assessment tools among children with autism spectrum disorder (ASD).MethodPubMed, CINAHL, PsycINFO, Scopus, ERIC and Web of Science were searched for English-language articles published 1/1990–8/2022. Studies of children with ASD, 3–18-years old, using performance-based standardized motor assessment tools, were included. ASD sample characteristics, enrollment criteria, accommodations and missing motor outcome data were synthesized.ResultsAmong 5,432 references, 180 studies using 11 assessments were included. The most frequently used tools were the Movement Assessment Battery for Children, Bruininks-Oseretsky Test of Motor Proficiency and the Test of Gross Motor Development. Large-scale studies were lacking, and girls underrepresented. Low cognitive level was an exclusion criterion explicitly or as a related criterion in 87 (48%) studies. Behavioral issues were noted anecdotally. Methodological detail varied, particularly regarding missing data, administrators’ professions, training and inter-rater reliability. Seventy-four studies reported a total of 197 accommodations, related mainly to modifications of the tasks, accommodations to the testing procedure and changes in the physical setting in which the test was conducted.ConclusionsThe findings, building on previous reports, indicate that children and adolescents with ASD cannot be approached uniformly over the entire spectrum of intelligence (IQ) and behavioral profiles in motor assessments. Administration challenges may stem from ASD characteristics beyond cognitive ability. Inconsistency relating to the IQ variable and incomplete methodological reports continue to be obstacles to comparative conclusions. ASD-specific versions of the tools with a supplementary report, describing cooperation, off-task behaviors and engagement, and combining several tools are recommended. This review could inform development of guidelines regarding motor assessments for children with ASD.     

The cost-effectiveness of treatments for attention deficit-hyperactivity disorder and autism spectrum disorder in children and adolescents: a systematic review

European Child & Adolescent Psychiatry - Economic evaluations can help decision makers identify what services for children with neurodevelopmental disorders provide best value-for-money. The...     

Family level processes associated with outcomes for individuals with autism spectrum disorder: A scoping review

BackgroundFamilies of individuals with autism spectrum disorder (ASD) face distinct challenges, and there is a need for research that attends specifically to the family. Despite the recognition of reciprocal influences in the family, research on families of individuals with ASD has tended to focus on child effects within a dyadic subsystem and not necessarily family effects. Thus, this review focuses on whether and how family processes are associated with the behavioral, social, and/or emotional development of individuals with ASD.MethodA scoping review was conducted to synthesize existing empirical literature regarding links from family functioning to individual outcomes. Family systems approaches are used along with ecological models to provide an inclusive, guiding framework for research design and interpretation of findings in family-based ASD research.ResultsResults suggest that family-wide factors such as adaptability, cohesion, social support, dynamics, and functioning may be important for child development. However, the heterogeneity of the body of literature reviewed makes definitive conclusions difficult.ConclusionsRecommendations for future research, including the need for theoretically grounded, developmentally appropriate, models that highlight the unique strengths, challenges, and cultural influences of families of an individual with ASD are discussed.     

Effect of a ketogenic diet on autism spectrum disorder: A systematic review

Autism spectrum disorder (ASD) is primarily characterized by impaired social interaction and communication, as well as restricted repetitive behaviours and interests. The utilization of the ketogenic diet (KD) in different neurological disorders has become a valid approach over time, and recently, it has also been advocated as a potential therapeutic for ASD. A MEDLINE, Scopus and Cochrane search was performed by two independent reviewers to investigate the relationship between ASD and the KD in humans and experimental studies. Of the eighty-one potentially relevant articles, eight articles met the inclusion criteria: three studies with animals and five studies with humans. The consistency between reviewers was κ = 0.817. In humans, the studies mainly focused on the behavioural outcomes provided by this diet and reported ameliorated behavioural symptoms via an improved score in the Childhood Autism Rating Scale (CARS). The KD in prenatal valproic acid (VPA)-exposed rodents, as well as in BTBR and Mecp2 mice strains, resulted in an attenuation of some autistic-like features. The limited number of reports of improvements after treatment with the KD is insufficient to attest to the practicability of the KD as a treatment for ASD, but it is still a good indicator that this diet is a promising therapeutic option for this disorder.     

Psychopharmacologic intervention for adults with autism spectrum disorder: A systematic literature review

BackgroundThe increased recognition of psychiatric and behavioural disorder in adults with autism spectrum disorder (ASD) has been associated with more frequent use of psychopharmacologic intervention in this population. However, limited evidence supports the effectiveness of these interventions for adults with ASD.ObjectiveTo review and synthesise the evidence regarding the effectiveness of psychotropic medication in reducing behavioural disturbance in adults with ASD.Data sources and study selectionElectronic literature search of PubMed plus manual reference checks of all articles on psychopharmacology in adults with ASD published in the English language between 1985 and 2015.Results and conclusionsA total of 43 studies were included in the analysis. The results indicate that only two medications, fluoxetine and risperidone, can be considered as promising evidence-based practices for adults with ASD. Given the rising prevalence of ASD, along with increased use of psychopharmacologic intervention in this population, there is a clear need for methodologically rigorous research to establish the effectiveness of these interventions. The subsequent establishment of clinical guidelines for medication use in this population is essential.     

Transcranial direct current stimulation for migraine: a systematic review and meta‐analysis of randomized controlled trials

BackgroundTranscranial direct current stimulation (tDCS) is a promising method for migraine treatment. In this study, we investigated the efficacy and safety of tDCS for migraine by conducting a systematic review and meta‐analysis of randomized controlled trials (RCTs).MethodsWe searched PubMed, EMBASE, Cochrane Library, and Web of Science up to December 02, 2021 for RCTs reporting tDCS for migraine treatment. Two authors independently evaluated the eligibility of the retrieved trials and extracted relevant data. Outcomes for the quantitative synthesis were reduction in migraine days per month and adverse events.ResultsEleven RCTs that included 425 patients with migraine were evaluated in the meta‐analysis. The efficacy and safety of anodal or cathodal stimulation targeting different brain areas, including primary motor cortex (M1), primary sensory cortex (S1), dorsolateral prefrontal cortex (DLPFC), and visual cortex (VC), were assessed in the RCTs enrolled. We found that tDCS with M1 and VC activation could reduce No. of migraine days per month in patients with migraine. Meanwhile, tDCS with VC inhibition could also reduce No. of migraine days per month in patients with migraine. However, there were no differences in the incidence of adverse events between the two groups.ConclusiontDCS activates M1 or activates/inhibits VC which could improve migraine symptoms. tDCS is an effective, preventive, and safe treatment for migraine.     

Teaching individuals with autism spectrum disorder to ask questions: A systematic review

This review involved a systematic search and analysis of studies aimed at teaching individuals with autism spectrum disorder (ASD) to ask questions (i.e., teaching mands for information). A systematic search of databases, reference lists, and journals identified 21 studies that met predetermined inclusion criteria. Included studies were then summarized in terms of (a) participant characteristics, (b) dependent variables (e.g., types of question-asking skills that were taught), (c) intervention procedures, (d) research designs, and (e) outcomes. All 21 studies reported that participants acquired or improved in the targeted question-asking skills. The most common intervention components included (a) echoic prompts and systematic fading procedures (e.g., time delay), (b) positive reinforcement via provision of requested information and/or access to preferred items or activities, and (c) contriving situations to motivate specific questions (i.e., creating establishing operations). Implications for practitioners and directions for future research are discussed.     

A systematic review of weighted vests with individuals with autism spectrum disorder

The purpose of the study was to evaluate the current literature on the use of weighted vests (WV) with individuals with autism spectrum disorder (ASD). A literature review using the standards recommended by the What Works Clearinghouse was conducted. The studies included in the review met the following criteria: (a) use of a single case research design; (b) inclusion of at least one individual with ASD; (c) examination of the effects of WV on a particular dependent variable; and (d) publication in English in a peer-refereed journal in the past 25 years. The results of the review show that the use of WV with individuals with ASD is not an evidence-based practice.