NEUROMODULATION IN PEDIATRIC OBSESSIVE-COMPULSIVE DISORDER: A SYSTEMATIZED NARRATIVE REVIEW EMPHASIZING SEVERE AND TREATMENT-RESISTANT PRESENTATIONS

Laura Mikuła; Julia Sposób; Justyna Strycharczuk; Wiktoria Wiśniewska; Wiktoria Jarosiewicz; Aleksandra Kowalewska-Kurek; Katarzyna Kowalska; Daria Krzyżanowska

doi:10.31435/ijitss.3(51).2026.6218

Authors

Laura Mikuła Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0000-4827-2492
Julia Sposób Medical University of Warsaw, Żwirki i Wigury 63A, 02-091 Warsaw, Poland https://orcid.org/0009-0000-2266-6899
Justyna Strycharczuk Independent Public Healthcare Institution of the Ministry of the Interior and Administration in Opole, Krakowska 44, 45-075 Opole, Poland https://orcid.org/0009-0002-6612-2070
Wiktoria Wiśniewska Mazowiecki Szpital Bródnowski, Kondratowicza 8, 03-242 Warsaw, Poland https://orcid.org/0009-0003-7401-419X
Wiktoria Jarosiewicz Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0009-7804-8999
Aleksandra Kowalewska-Kurek University Clinical Hospital No. 2 of the Pomeranian Medical University (PUM) in Szczecin, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland https://orcid.org/0009-0004-7686-0872
Katarzyna Kowalska M. Kopernik Provincial Multispecialty Oncology and Traumatology Center in Łódź, Pabianicka 62, 93-513 Łódź, Poland https://orcid.org/0000-0001-6027-2620
Daria Krzyżanowska Salve Medica, Rzgowska 50a Street, 93-172, Łódź, Poland https://orcid.org/0009-0002-5349-5679

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6218

Keywords:

Obsessive-Compulsive Disorder; Child; Adolescent; Transcranial Magnetic Stimulation; Transcranial Direct Current Stimulation; Deep Brain Stimulation

Abstract

Objective: Pediatric obsessive-compulsive disorder (OCD) is usually managed with cognitive-behavioral therapy with exposure and response prevention and selective serotonin reuptake inhibitors, yet a subset of patients remains severely symptomatic. This review evaluates the pediatric evidence for transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS), with emphasis on severe or treatment-resistant OCD.

Methods: We conducted a systematic narrative review of English-language literature published between 2015 and 2025. Searches were performed in PubMed/MEDLINE and Google Scholar and supplemented by reference-list screening. Eligible sources included pediatric or adolescent clinical studies, case reports, protocols and implementation-relevant ethical or developmental literature concerning TMS, tDCS, or DBS for OCD.

Results: Twenty-eight records were included. Pediatric evidence was sparse and heterogeneous, with few controlled data and limited follow-up. TMS was the most frequently described modality and was supported mainly by observational studies, case reports, and extrapolation from adult OCD literature. One sham-controlled adolescent tDCS trial reported improvement in both active and sham groups, without clear between-group superiority. No prospective pediatric DBS trials for primary OCD were identified; available evidence was limited to isolated cases, comorbid neuropsychiatric cohorts, and stakeholder or ethics studies.

Conclusions: Current evidence does not support routine neuromodulation for pediatric OCD. TMS appears closest to cautious clinical translation in specialist settings, whereas tDCS should remain research-focused. DBS should be restricted to exceptional, severe, treatment-refractory cases under multidisciplinary review, robust ethical oversight and developmentally appropriate consent or assent procedures.

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