The Developing Brain—Relevance to Pediatric Neurotechnology

Abstract Neurostimulation protocols to measure or modulate regional brain excitability are rapidly emerging as research and clinical tools with utility across ages. Clinicians and investigators, in the pediatric neurosciences in particular, are poised to apply these technologies in the near future in a range of neuro- and psychopathologies (Frye et al., 2006; Ziemann et al., 2008; Rajapakse and Kirton, 2013; Palm et al., 2016; Hameed et al., 2017) As often underscored by child neurologists, the developing brain is a unique physiological entity, and not merely a small adult brain. Important developmental trajectories of neurogenesis, synaptogenesis, myelination, and other components of brain growth are accompanied, at the molecular level, by developmental changes in γ-aminobutyric acid–mediated inhibition, glutamate-mediated excitation, and use-dependent synaptic plasticity. (An et al., 2012; Cao and Harris, 2012; Guerriero et al., 2015; Rakhade and Jensen, 2009; Sanchez and Jensen, 2001; Mix et al., 2015; Eyre, 2003; Tau and Peterson, 2010) Insights into these trajectories are largely derived from preclinical in vitro and ex vivo experiments as described below. As the therapeutic effects of noninvasive brain stimulation rely on these cellular and molecular mechanisms of excitability and plasticity, the design of effective pediatric brain stimulation protocols requires careful consideration of the maturational patterns of these basic neurophysiological mechanisms.