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WithdrawnNCT03368469Updated Jan 18, 2020

Transcranial Direct Current Stimulation (tDCS) in Children and Adolescents With Epilepsy and Depression

An interventional study of transcranial direct current stimulation in Depressive Disorder and Generalized Epilepsy, sponsored by Mayo Clinic. Withdrawn at 1 site in United States. Open to participants aged 10 Years to 21 Years. Per ClinicalTrials.gov, last updated 2020-01-18.

Sponsored by Mayo Clinic · Not applicable, Interventional, and Treatment

Why this study was withdrawn
The study team was unable to recruit and enroll subjects. The study is now closed.
Phase
Not applicable
Study type
Interventional
Enrollment
0
Allocation
Not applicable
Ages
10 Years to 21 Years
Sex
All
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Study summary

The proposed study seeks to obtain preliminary signal of the tolerability and efficacy of transcranial direct current stimulation (tDCS) for depressive symptoms in a sample of adolescents with depression and epilepsy. Additionally, effects of tDCS will be assessed via electroencephalographic, cognitive, and psychosocial measures.

Read the detailed description

Transcranial direct current stimulation (tDCS) has been investigated extensively in recent years for the treatment of depression. Meta-analysis of individual patient data indicates that tDCS results in improvement in depressive symptoms, with efficacy comparable to antidepressant medications and repetitive transcranial magnetic stimulation (rTMS), while tDCS offers advantages over other treatments, including side effect profile, cost, and portability. tDCS has been employed to a more limited extent in children and adolescents for psychiatric conditions other than depression, as well as in both adults and children with epilepsy, with excellent tolerability and a mild adverse effect profile. The proposed protocol aims to extend the use of tDCS for treatment of depression in children with epilepsy (CWE), a population with a very high prevalence of depression and a significant need for additional treatment options, particularly nonpharmacologic treatments, due to challenges with the use of antidepressant medications and other non-invasive brain stimulation (NIBS) techniques in CWE.

02

Conditions studied

  • Depressive Disorder
  • Generalized Epilepsy

Keywords

  • Transcranial
  • Stimulation
03

Who can participate

Ages eligible
10 Years to 21 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Diagnosis of generalized epilepsy (confirmed by neurologist)
  • Diagnosis of depressive disorder (confirmed by psychiatrist), with CDRS-R score ≥ 40
  • Parent/guardian ability to provide written informed consent in English, with child/adolescent participant able to provide assent (for participants \<18 years of age), or participant ability to provide written informed consent in English (for participants ≥18 years of age)
  • Antidepressant medications (SSRI or SNRI) permitted, provided that no dosing change has occurred in two months prior to baseline assessments; antidepressant medication not required for enrollment
  • AED medications (with exceptions listed below in exclusion criteria) permitted, provided that no change in AED regimen has occurred in two months prior to baseline assessments (except for weight/growth-related dosing changes); AED not required for enrollment

Exclusion criteria

Exclusion Criteria:

  • Presence of pacemaker or metallic implant (with the exception of orthodontic hardware)
  • Prior surgical intervention for epilepsy
  • More than one generalized tonic-clonic (GTC) seizure during two months prior to enrollment
  • AED regimen change during two months prior to baseline assessments (except dosing adjustments made strictly due to growth/weight change)
  • Antidepressant medication change during two months prior to baseline assessments
  • Lifetime history of manic/hypomanic episode or psychotic disorder
  • Autism spectrum disorder (ASD) diagnosis
  • Documented history of intellectual disability (documented full-scale IQ greater than two standard deviations below mean)
  • Current or recent (two months prior to baseline assessments) active substance use disorder
  • Imminent risk of suicide or medically serious self-injurious behavior (as evaluated by board-certified child and adolescent psychiatrist)
  • Current pregnancy or positive urine pregnancy test
  • Prohibited concomitant medications include: regularly scheduled benzodiazepines (except clobazam); barbiturates; neuroleptic/antipsychotic medications; lithium.
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
0 participants (actual)

Study arms

  • Experimental
    transcranial direct current stimulation

    Transcranial direct current stimulation (35 sq cm anode over left dorsolateral prefrontal cortex, 35 sq cm cathode over right supraorbital area, 1 mA current, 20 min per treatment session, 1 session per day, 10 treatment sessions over two weeks)

    Device: transcranial direct current stimulation

Interventions

  • Devicetranscranial direct current stimulation

    The Soterix Medical 1×1 Low Intensity Transcranial DC Stimulator Model 1300A is an investigational device manufactured by Soterix Medical, Inc. (New York, NY, USA). It is designed for use in noninvasive transcranial stimulation of the brain by delivering low-intensity electrical current to the scalp through two electrodes.

    Also known as: Soterix Medical Model 1300A

05

What researchers measure

Primary outcomes

  1. Children's Depression Rating Scale - Revised (CDRS-R) total score

    clinician-rated continuous measure of depression severity based on participant and parent interviews

    Time frame: 2 weeks

Secondary outcomes

  1. Children's Depression Rating Scale - Revised (CDRS-R) total score

    clinician-rated continuous measure of depression severity based on participant and parent interviews

    Time frame: 3 months, 6 months

  2. Quick Inventory of Depressive Symptoms - Adolescent - Self-Report (QIDS-A17-SR) total score

    participant-reported continuous measure of depression severity

    Time frame: day 1, day 5, day 10, 3 months, 6 months

  3. tDCS Adverse Effects Survey

    standardized self-report questionnaire for active reporting of adverse effects; will be used to calculate incidence of all adverse effects (AEs) and severe adverse effects (SAEs) as well as incidence of specific AEs/SAEs

    Time frame: days 1-10, 2 weeks, 3 months, 6 months

  4. Columbia Suicide Severity Rating Scale (C-SSRS)

    measure of suicidal ideation and behavior based on clinician interview

    Time frame: day 1, day 5, day 10, 2 weeks, 3 months, 6 months

  5. Young Mania Rating Scale (YMRS)

    measure of manic symptoms based on clinician interview/observation

    Time frame: day 5, 2 weeks

  6. Affective Reactivity Index (ARI)

    parent- and participant-report questionnaires regarding symptoms of irritability

    Time frame: 2 weeks, 3 months, 6 months

  7. Mayo Seizure Frequency Assessment

    parent- and participant-report questionnaires regarding seizure frequency

    Time frame: 2 weeks, 3 months, 6 months

  8. Liverpool Seizure Severity Scale (1998 revision)

    parent-/participant-report questionnaire regarding seizure severity and quality

    Time frame: 2 weeks, 3 months, 6 months

  9. Impact of Pediatric Epilepsy Scale (IPES)

    parent-report questionnaire regarding impact of epilepsy of quality of life

    Time frame: 2 weeks, 3 months, 6 months

  10. Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48)

    participant-report questionnaire regarding impact of epilepsy of quality of life

    Time frame: 2 weeks, 3 months, 6 months

  11. NIH Toolbox® for Assessment of Neurological and Behavioral Function

    validated and age-normed computer-administered battery of measures assessing cognitive functioning

    Time frame: 2 weeks

  12. Electroencephalography (EEG)

    objective electrophysiologic data on brain activity; a board-certified epileptologist will manually quantify the maximal number of spike-wave discharges per 20-second recording, the longest run of epileptiform discharges, and, if sleep EEG is obtained, the spike-wave index; additionally, broadband EEG will be obtained to assess indices of cortical excitability, such as relationships between slow oscillations, interictal epileptiform discharges, and sleep architecture

    Time frame: 2 weeks

06

Study locations

1 site
  • Mayo Clinic
    Rochester, Minnesota 55905, United States
07

References and documents

Publications

  • Lee JC, Lewis CP, Daskalakis ZJ, Croarkin PE. Transcranial Direct Current Stimulation: Considerations for Research in Adolescent Depression. Front Psychiatry. 2017 Jun 7;8:91. doi: 10.3389/fpsyt.2017.00091. eCollection 2017. PubMed 28638351 ↗
  • Hameed MQ, Dhamne SC, Gersner R, Kaye HL, Oberman LM, Pascual-Leone A, Rotenberg A. Transcranial Magnetic and Direct Current Stimulation in Children. Curr Neurol Neurosci Rep. 2017 Feb;17(2):11. doi: 10.1007/s11910-017-0719-0. PubMed 28229395 ↗
  • Muszkat D, Polanczyk GV, Dias TG, Brunoni AR. Transcranial Direct Current Stimulation in Child and Adolescent Psychiatry. J Child Adolesc Psychopharmacol. 2016 Sep;26(7):590-7. doi: 10.1089/cap.2015.0172. Epub 2016 Mar 30. PubMed 27027666 ↗
  • Godinho MM, Junqueira DR, Castro ML, Loke Y, Golder S, Neto HP. Safety of transcranial direct current stimulation: Evidence based update 2016. Brain Stimul. 2017 Sep-Oct;10(5):983-985. doi: 10.1016/j.brs.2017.07.001. Epub 2017 Jul 8. No abstract available. PubMed 28751225 ↗
  • Krishnan C, Santos L, Peterson MD, Ehinger M. Safety of noninvasive brain stimulation in children and adolescents. Brain Stimul. 2015 Jan-Feb;8(1):76-87. doi: 10.1016/j.brs.2014.10.012. Epub 2014 Oct 28. PubMed 25499471 ↗
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Registry details

Key details

Study ID
NCT03368469
Lead sponsor
Mayo Clinic
Responsible party
Paul E. Croarkin (Principal Investigator, Mayo Clinic) — Principal investigator
First posted
Dec 11, 2017
Start date
Feb 23, 2018
Primary completion
Jan 2019 (estimated)
Completion
Jan 2019 (estimated)
Last update
Jan 18, 2020

Study contacts

Paul E Croarkin, DO
principal investigator · Mayo Clinic

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
View the source record on ClinicalTrials.gov ↗

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