Neuromodulation for pediatric disorders of consciousness lacks specific pediatric evidence

This systematic review synthesized evidence on neuromodulation for pediatric disorders of consciousness (pDoC), examining non-invasive techniques like transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), as well as invasive deep brain stimulation (DBS). The evidence is derived from adult studies, as specific pediatric clinical trials or outcome data were not reported. The population of interest is the pediatric population, but no sample size, comparator, primary outcomes, or follow-up duration were specified.

The main finding is that translating adult neuromodulation evidence to children is significantly hindered. This is due to a fundamental lack of specific evidence for pDoC and the physiological complexities of the developing brain, which invalidate a 'miniature adult' approach. No efficacy or safety data—including adverse events, serious adverse events, or discontinuation rates—were reported for pediatric applications.

Key limitations include the lack of specific evidence for the pediatric population and the anatomical and physiological disparities between developing and adult brains. The review notes unique ethical dilemmas and safety challenges in this population. The practice relevance is not reported, and funding or conflicts of interest were not disclosed. Given the complete absence of pediatric-specific efficacy and safety data, these adult-derived findings have no direct clinical applicability for treating pDoC at this time.