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

Abstract

Repetitive Transcranial magnetic stimulation (rTMS) is emerging as a new investigation as well as treatment tool for various neurological and psychiatric diseases. Recent studies showed its application as treatment tool in movement disorders, where rTMS stimulation on primary motor cortex alters physiological patterns of motor threshold; motor evoked potential and cortical plasticity which induces motor activity. Recent studies on rTMS combined with rehabilitation therapy demonstrated functional improvement in motor activities of spastic cerebral palsy (sCP) children. Thus, this study was designed to evaluate the effect of rTMS on hand function of sCP patients.Forty-five children diagnosed as sCP participated in this study after written consent from their parents or guardians. They were divided into three groups-control (CG) and interventional group (IG-A and IG-B). Participants in CG were provided only physical therapy (PT) of 30 minutes duration daily for 20 days and those in IG were administered rTMS frequency of 5Hz (IG-A) and 10Hz (IG-B) for 15 minutes consisting of 1500 pulses daily for 20 days; followed by PT as given to CG. Quality of upper extremity skill test (QUEST) scoring was used for evaluating the improvement in hand function of sCP patients. The pre (before starting any therapy) versus post (after completion of 20 sessions) mean QUEST score between different groups were statistically significant (p<0.01) and the mean change was 0.61, 2.46 and 2.87 in CG, IG-A and IG-B respectively.However, encouraging functional improvement in hand function was observed in diplegic patients in the age group of 2-6 years employing 5Hz frequency and higher frequency (10Hz) induced better activity in hemiplegic and quadriplegic patient of older age groups (7-16 years).

Increasing number of therapy sessions of repetitive transcranial magnetic stimulation improves motor development by reducing muscle spasticity in cerebral palsy children

“…It has been previously stated and determined in our studies that rTMS was more effective than PT or standard therapy alone in control group. [16171819] These interesting results can lead to better acceptability of a new treatment regime for CP that is required for inducing faster gain in motor activity and in achieving developmental milestone since these children show delayed motor and cognitive growth patterns.…”

“…[1415] In addition, our previous experience on treating spastic CP children with rTMS combined with PT has demonstrated that higher frequency of 10 Hz was more effective than 5 Hz both in improving motor activity and reducing muscle spasticity by keeping patient safety in mind. [161718] Moreover, when variation in pulse train was studied, keeping rTMS frequency of 10 Hz constant, it was found that pulse of 2500 leads to decrease in muscle spasticity as compared to 1500 and 2000 pulses again not compromising on patient safety due to high dosages involved. [19] Now, in the current study, for the first time, we report the effect of rTMS on motor functions and muscle spasticity of spastic CP children by varying the number of therapy sessions to be administered.…”

Effect of Repetitive Transcranial Magnetic Stimulation on Cognition in Spastic Cerebral Palsy Children

“…The stimulation modulates the cortical excitability by producing physiological and functional changes in cerebral cortex. These changes help in neuromodulator that helps in treatment of movement disorder and various neurological disorders [6]. Application of rTMS in cognition was thoroughly review by V. Walsh et al, where many neurological diseases related to cognitive ability were discussed [7].…”