Wall, Christopher A.

Objective: Preliminary studies suggest that repetitive transcranial magnetic stimulation (rTMS) may be an effective and tolerable intervention for adolescents with treatment-resistant depression. There is limited rationale to inform coil placement for rTMS dosing in this population. We sought to examine and compare three localization techniques for coil placement in the context of an open-label trial of high-frequency rTMS for adolescents with treatment-resistant depression. Methods: Ten adolescents with treatment-resistant depression were enrolled in an open-label trial of high-frequency rTMS. Participants were offered 30 rTMS sessions (10 Hz, 120% motor threshold, left 3000 pulses applied to the dorsolateral prefrontal cortex) over 6–8 weeks. Coil placement for treatment was MRI guided. The scalp location for treatment was compared with the locations identified with standard 5 cm rule and Beam F3 methods. Results: Seven adolescents completed 30 rTMS sessions. No safety or tolerability concerns were identified. Depression severity as assessed with the Children's Depression Rating Scale Revised improved from baseline to treatment 10, treatment 20, and treatment 30. Gains in depressive symptom improvement were maintained at 6 month follow-up visits. An MRI-guided approach for coil localization was feasible and efficient. Our results suggest that the 5 cm rule, Beam F3, and the MRI-guided localization approaches provided variable scalp targets for rTMS treatment. Conclusions: Open-label, high-frequency rTMS was feasible, tolerable, and effective for adolescents with treatment-resistant depression. Larger, blinded, sham-controlled trials are needed for definitive safety and efficacy data. Further efforts to understand optimal delivery, dosing, and biomarker development for rTMS treatments of adolescent depression are warranted.

Objective: Clinical reviews of practice outcomes of adolescent patients who have received electroconvulsive therapy (ECT) remain relatively rare. This study reports the clinic practice and outcome of adolescents receiving ECT at a tertiary medical center. Methods: From April 1991 through November 2013, 51 adolescents (30 female; mean [SD] age, 16.8 [1.6] years) received ECT. The electronic medical record at the time of the first ECT session was reviewed for the clinical diagnosis, ECT lead placement and general administration, seizure duration, adverse effects, concurrent medications, and clinical outcome. Results: ECT was recommended for primary mood and psychotic disorders or catatonia. Patients received a mean (SD) of 9.3 (3.5) treatments, with initial bitemporal lead placement in 36 patients (71%). Thirty-nine patients (77%) were much or very much improved based on Clinical Global Impressions–Improvement scale at the end of the acute treatment. Prolonged seizure duration (>120 seconds) was relatively common (63%) but appeared to decrease in older patients. Conclusions: This report describes the largest group of adolescents receiving ECT since 1947, and supports ECT as a safe and effective modality for most treatment-recalcitrant psychiatric illness in youth.

Proton magnetic resonance spectroscopy (1H‐MRS) is a safe, noninvasive way of quantifying in vivo biochemical and metabolite concentration levels in individuals withAutismSpectrumDisorders (ASD). Findings to date suggestASDis associated with widespread reduction inN‐acetylaspartate (NAA), creatine plus phosphocreatine (Cr), choline‐containing compounds (Cho),myo‐inositol (mI), and glutamate plus glutamine plus gamma‐Aminobutyric Acid (Glx); however, variable findings, and even substantial increases, are not uncommon depending on the study and/or region‐of‐interest. Widespread reduction ofNAA,Cr,Cho,mI, andGlxinASDlikely reflects impaired neuronal function and/or metabolism related to abnormal neurodevelopmental processes. Future studies should attempt to relate1H‐MRSfindings to histological findings and control for variability in subject age and functioning level; this would assist in evaluating the relationship between1H‐MRSmetabolic levels and neuronal and glial cell densities, as well as neurodevelopmental process associated withASD. Furthermore, more longitudinal1H‐MRSstudies are needed in both control andASDsubjects to attempt to standardize metabolite levels across different developmental periods in well‐defined endophenotypes. This will provide for a standard rubric for which metabolic aberrations (as well as treatment responses) can be measured. With higher magnetic field strengths and spectral‐editing techniques capable of quantifying less‐concentrated metabolites,1H‐MRSwill continue to be an important tool inASDresearch.Autism Res2013, 6: 119–133.© 2013 International Society for Autism Research, Wiley Periodicals, Inc.

This case study followed one adolescent patient who underwent bilateral deep brain stimulation of the centromedian parafascicular complex (CM-Pf) for debilitating, treatment refractory Tourette's syndrome for a period of 1.5 years. Neurocognitive testing showed no significant changes between baseline and follow-up assessments. Psychiatric assessment revealed positive outcomes in overall adaptive functioning and reduction in psychotropic medication load in this patient. Furthermore, despite significant baseline psychiatric comorbidity, this patient reported no suicidal ideation following electrode implantation. Deep brain stimulation is increasingly being used in children and adolescents. This case reports on the positive neurologic and neuropsychiatric outcome of an adolescent male with bilateral CM-Pf stimulation.