Emerging therapy
Magnetic stimulation
rTMS, theta-burst stimulation, TMS
The most clinically established technique on this site. Approved for some uses in older adolescents, with its best paediatric results when it is paired with intensive physiotherapy or occupational therapy rather than given on its own.
Randomised or controlled trials in children are under way or completed, but the result is not yet settled enough for routine care. Taking part in a registered trial is reasonable; treating it as established care is not.
Where it stands, condition by condition
The same therapy can be well supported for one problem and completely untested for another. This is the single most common place families are misled.
| Condition | Evidence | What that means here |
|---|---|---|
| Adolescent depression | Established care | Regulators in some countries have cleared repetitive TMS as an add-on treatment in older adolescents. Approval is specific to that indication, age range and device. |
| Autism — repetitive behaviours and stereotypies | In clinical trials | This is where the autism signal is most consistent. Low-frequency protocols over the dorsolateral prefrontal cortex have repeatedly reported reductions in repetitive behaviours and stereotypies, alongside changes on attention and event-related potential measures. Much of the work comes from a small number of groups and the trials are modest in size, so it is not yet established care — but the direction has held across studies. |
| Hemiparetic cerebral palsy — upper limb | In clinical trials | The strongest paediatric motor evidence, and it depends on combination. Randomised work pairing low-frequency rTMS over the uninvolved hemisphere with intensive constraint or bimanual therapy has found the combined arm doing better than either component alone. Read as an amplifier of good hand therapy it has a real case; read as a stand-alone treatment it does not. |
| Cerebral palsy — gait and lower limb | Early research only | Much less studied than the upper limb, with smaller series and less consistent results. |
| Epilepsy | Early research only | Low-frequency protocols have been explored for focal epilepsy. Evidence is limited, and stimulation parameters matter for safety. |
What it is
A coil placed against the scalp produces brief magnetic pulses that induce small electrical currents in the cortex just beneath it. The child is awake; there is no anaesthetic.
Repetitive TMS delivers trains of pulses to shift the excitability of a target area — higher frequencies generally increase it, lower frequencies generally reduce it. Theta-burst protocols achieve similar effects in a much shorter session.
TMS is also used purely as a measurement tool, to map motor pathways. That diagnostic use is well established and should not be confused with treatment.
How it is meant to work
Repeated stimulation is thought to change the strength of synaptic connections — the same plasticity mechanisms that underlie ordinary learning.
That has a practical consequence: stimulation is usually paired with therapy, on the reasoning that it opens a window in which practice is more effective. Stimulation alone, with nothing to practise, has less rationale.
What has actually been tested
- Repetitive TMS has been cleared by regulators as an adjunctive treatment for depression in older adolescents in some countries — a real approval, for a narrow indication.
- In autism, controlled studies of several protocols have been published over more than a decade. The most repeatable finding is a reduction in repetitive behaviours and stereotypies with low-frequency protocols over the dorsolateral prefrontal cortex, supported by changes on attention and electrophysiological measures. The caution here is concentration of the evidence rather than absence of it: much of it comes from a few centres, with small samples.
- In cerebral palsy the combination is the finding. The more convincing designs pair low-frequency stimulation of the uninvolved hemisphere with intensive constraint or bimanual upper-limb therapy and measure hand function. Children receiving both have done better than those receiving either alone — which fits the mechanism exactly: stimulation opens a window and therapy fills it. It is also why a centre offering stimulation with no therapy programme attached is offering half the intervention.
- Paediatric safety has been examined systematically. Expert consensus work has concluded that, within published parameter limits, TMS is generally well tolerated in children.
What we still do not know
- Which cortical target and protocol suit which child — site selection is often inferred rather than individualised.
- How long any effect lasts, and whether maintenance sessions are needed.
- Whether gains translate into everyday function rather than test scores.
- Whether findings from adults apply to a brain that is still organising.
Risks and unwanted effects
- Scalp discomfort, headache and transient hearing effects without ear protection are the common ones.
- Seizure is the serious risk. It is rare, and it is the reason published parameter limits exist and why a child with epilepsy needs the protocol reviewed by their neurologist beforehand.
- Metallic implants near the head, cochlear implants and certain devices are contraindications that must be checked before the first session.
- Effect sizes are modest, so treatment usually requires long and repeated session series.
Questions to ask before you agree
A centre that is doing good work will welcome these questions and answer them in writing.
- What target, frequency, intensity relative to motor threshold, and number of sessions — and do these fall inside published paediatric safety limits?
- Does my child have any seizure risk, and who reviewed the protocol for that?
- Is stimulation paired with therapy, and which therapy?
- What is measured before and after, and when do we decide it is not working?
More in this section
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Several different products share this name. Some are licensed medicines for blood disorders; none is a licensed treatment for cerebral palsy or autism anywhere in the world.
Early research onlyExosomes
The cell-free next step after stem cells, with genuinely interesting laboratory science — and, in children, almost no controlled clinical evidence at all.
Early research onlyMuse cells
A distinct, well-characterised cell type with an unusual biology — it appears to find damaged tissue on its own — supported by a substantial laboratory literature and an early but real clinical programme. Controlled paediatric efficacy data are not yet available.
Early research onlyPhotobiomodulation
Non-invasive, painless and simple to deliver compared with cell therapies, with a literature that is growing quickly and is mostly positive. The studies are still small and short, so the open question is not whether anything happens but how large the effect is and how long it lasts.
Early research onlyPeptide preparations
Two quite different things share this word: prescription neuropeptide preparations used routinely in some countries, and an unregulated wellness trade. Neither has good evidence in children.
Early research onlyMedicinal mushrooms and nootropics
A research band worth watching, and a supplement shelf to approach carefully. Some of these compounds have real laboratory interest; almost none has been tested in children with neurological conditions.
Established careCannabidiol and cannabis-based products
The one product in this group that became a real medicine. Licensed for three named epilepsy syndromes, and supported beyond them by a large body of real-world evidence in other drug-resistant epilepsies. The oil sold in a shop and the licensed solution are still not the same thing.
Not supported by evidenceChelation therapy
The idea behind it was tested and failed. There is no trial evidence that it helps an autistic child, there is a documented record of children harmed, and at least one child has died. This is the clearest no on this site.
Early research onlyProbiotics, prebiotics and the gut–brain axis
Genuinely interesting science with a few solid, specific uses in children — and a large gap between those uses and what is sold to families of autistic and neurologically disabled children.