Leading the way in pediatric stroke therapy using TMS
Some babies have a tough entry into the world, suffering a stroke just before or as they are born. Although the cause of most perinatal strokes is unknown, kids who have them are usually affected by a type of cerebral palsy called hemiparesis, which causes weakness on one side of the body. This is incredibly debilitating and treatment options are limited. It is estimated there are about 1,000 kids - from infants to teenagers - in Alberta living with aperinatal stroke.
With the exciting results of a study by Dr. Adam Kirton, occupational therapists at the hospital have now been trained on constraint therapy to help rehabilitate more children who have suffered a perinatal stroke. The research has opened the door for further studies on the impacts of non-invasive brain stimulation treatments, like Transcranial Magnetic Stimulation (TMS).
This innovative work has created a strong foundation for a new, multi-centre trial and is a crucial stepping stone in the process of having TMS become a routine therapy for eligible patients. The hospital is currently the only facility in Canada using non-invasive brain stimulation in children.
Thanks to support for the creation of Canada’s only pediatric TMS lab, Dr. Kirton’s work continues to attract both national and global attention. He was awarded a grant of more than $2.8 million from the Canadian Institutes of Health Research to continue investigating therapies for pediatric stroke patients. As well, Dr. Kirton was invited to Vienna, Austria to speak about the strides made in Calgary at an International Symposium on Advances in Neuromodulation in Children.
Brain stimulation helping treat teen depression
Did you know only one out of two teens with depression responds to current frontline treatments? In Calgary, that translates to as many as 5,000 youths in urgent need of something else to help them deal with depression.
Specialists at the Alberta Children’s Hospital are studying a very promising and non-invasive treatment for these teens and others just like them all around the world. A team led by Dr. Frank MacMaster is using TMS to stimulate a section of the brain called the dorsal lateral pre-frontal cortex. It’s the part of the brain that regulates emotion, attention span and the ability to organize, plan and function as a responsible, productive adult.
During TMS, a magnetic field targets a small section of the brain – pre-mapped by an MRI – and allows specialists to alter its level of stimulation.
“This part is like the boss of the brain,” says Dr. MacMaster. “TMS allows us to make it work more effectively to control symptoms. So far we are seeing some incredibly positive results.”
More than three quarters of the participants have responded to the treatment and more than half of them have had their symptoms reduced by over 50%. This is an incredible success, considering these patients haven’t responded to traditional treatments, such as anti-depressants and cognitive behavioural therapy.
While developing TMS as a successful therapy for depression is one goal, Dr. MacMaster’s team is simultaneously identifying factors that would help specialists predict how effective the treatment might be for individual patients. They have already found some potential indicators of how well patients will respond to TMS, including blood flow and the thickness of the cortex.
Unlike drugs, which can take up to six months to show their effectiveness in youth with depression, Dr. MacMaster is able to tell as early as the second week into TMS treatment whether it’s making a difference for a patient. And, he says, relative to long-term and multiple-medication regimes or leaving depression untreated, TMS is a significantly lower risk option. Given its success so far, it may one day become the frontline treatment for depression in youth.
Dr. MacMaster’s group was approached by experts at the Mayo Clinic for help on two new collaborative projects. The first is a large-scale trial – with sites at the Alberta Children’s Hospital, the Mayo Clinic and the University of Cincinnati – to seek Food and Drug Administration (FDA) approval for TMS as a treatment for teens with depression. The second is to use the trial as a framework for a multi-site study on biological predictors of TMS response rates in youth with depression. This could result in the validation of the first precision medicine identifier in psychiatry.
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