Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients

Abstract

Spastic cerebral palsy (CP) is the one of most common neurological disorders occurring due to damage to the immature brain or any other brain lesion at the time of birth. To aid in making the life of the CP patient meaningful, several interventions such as medical, surgical and rehabilitation have been employed to date. Besides these, recently repetitive Transcranial magnetic stimulation (r-TMS) is a new found approach which is being employed for treating various neurological and psychological conditions. The aim of this study was to observe the effects of r-TMS on muscle spasticity in CP patients by stimulating the motor cortex area of the brain, which is responsible for muscle movements. In this study, 20 subjects diagnosed with CP were recruited and 10 each were placed in two groups, namely the research group (RG) (mean age, height and weight were 7.99 (SD = 4.66) years, 116.7 (SD = 23.57) cm and 21.40 (SD = 10.95) kg, respectively) and the control group (CG) (mean age, height and weight were 8.41 (SD = 4.32) years, 107.9 (SD = 26.33) cm, 21.40 (SD = 12.63) kg, respectively). r-TMS frequencies of 5 Hz and 10 Hz were administered for 15 min daily to patients in RG followed by standard therapy (ST) of 1 h duration daily for 20 days. Moreover, the patients in the control group (CG) were given only standard therapy (ST) of 1 h duration for 20 days. Modified Ashworth Scale (MAS) was used as an outcome measure to determine the level of muscle spasticity. A pre- assessment of MAS score was performed on both RG and CG to determine the level of spasticity prior to starting therapy; and similarly post-assessment after 20 days was done to observe the changes post-therapy. Statistical analysis of pre vs post MAS scores showed that few muscles showed reduction in muscle tightness after administering only ST in the CG. On the contrary, the RG that underwent r-TMS therapy combined with ST showed a significant decrease (p < 0.05) in muscle tightness for all the muscles selected for the therapy.

Spasticity Management: The Current State of Transcranial Neuromodulation

“…Based on the accumulated data from the literature survey, we can highlight 2 main points on the use of NINM for spasticity management: (1) NINM is useful in reducing spasticity, but its effects critically depend on the applied hemisphere and the underlying pathology [45]; and (2) NINM is more effective in reducing spasticity when coupled with another form of medical and/or physical therapy rather than used as a stand‐alone therapy [39,46‐48,56,58,65,70‐72].…”

“…Only a few reports support the conclusion that rTMS and tDCS are effective as a single intervention, whereas there is evidence suggesting that rTMS and tDCS contribute only by improving the outcomes of medical and/or physical therapy [39,46‐48,56,58,65]. The superiority of the combined approach may be justified by the principles of priming or of associative plasticity [29‐31].…”

“…Most of the studies used low‐frequency rTMS over the healthy hemisphere in stroke patients [44‐56] or the less affected side in the patients with multiple sclerosis [57]. Some studies used stand‐alone high‐frequency rTMS or intermittent theta‐burst stimulation (a type of high‐frequency rTMS in which patterned magnetic stimuli, ie, grouped in repeated small trains of stimuli, are used) [41,49,55‐64], combined high‐frequency with low‐frequency rTMS, or used combined approaches [46‐49,58,65]. Among the combined approaches, NINM was intended as a primer; that is, rTMS constituted a pretreatment or pre‐protocol stimulation that enhances the effect of subsequent treatments.…”

“…Concerning cerebral palsy, there are 2 studies that enrolled 17 patients [59] and 20 patients [65], respectively, aged 6‐12 years, who underwent standard high‐ and low‐frequency rTMS, paired with conventional physiotherapy. As compared to stand‐alone 1‐Hz rTMS and sham rTMS, the association between 5‐Hz rTMS and physiotherapy was found to be the only treatment efficacious in reducing spasticity significantly [59,65].…”

Effect of Repetitive Transcranial Magnetic Stimulation on Hand Function of Spastic Cerebral Palsy Children

“…Additionally, recent publications reported positive effect of rTMS in cerebral palsy [4] demonstrating improved motor activity [5,6] along with reduction in muscle tightness [7].…”