Neuromodulation for pediatric disorders of consciousness: bridging the gap between adult evidence and developmental reality

Pediatric disorders of consciousness (pDoC) impose a disproportionate lifelong burden on patients and families, yet therapeutic options remain discouragingly limited. While neuromodulation has emerged as a paradigm-shifting intervention for adults, its translation to the pediatric population is hindered by a lack of specific evidence and the physiological complexities of the developing brain. In this review, we bridge the gap between adult-derived findings and pediatric reality. We synthesize current evidence regarding non-invasive (tDCS, rTMS) and invasive (DBS) techniques, with a specific focus on the anatomical (e.g., skull conductivity) and physiological (e.g., synaptic plasticity) disparities that invalidate the “miniature adult” approach. Furthermore, we address the unique ethical dilemmas and safety challenges inherent to pediatric neurostimulation. Finally, we discuss the critical need for precision medicine, advocating for the integration of multimodal neuroimaging and computational head modeling to develop individualized, age-appropriate stimulation protocols.