Brain stimulation and constraint for perinatal stroke hemiparesis

Kirton, Adam; Andersen, John; Herrero, Mia; Nettel-Aguirre, Alberto; Carsolio, Lisa; Damji, Omar; Keess, Jamie; Mineyko, Aleksandra; Hodge, Jacquie; Hill, Michael D.

doi:10.1212/wnl.0000000000002646

Cited by 108 publications

(94 citation statements)

References 34 publications

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“…There were 81 adverse events that were attributed to rTMS protocols in the CNS disorder population (Table 2). The mild adverse events were as follows: headache (n=45) 15, 21, 64, 69-71, 75, 78 , dizziness (n=8) 66, 69, 70 , jaw twitching (n=4) 66 , nausea/vomiting (n=4) 21, 75 , anxiety (n=3) 69 , neck stiffness (n=3) 21 , tingling/dullness (n=3) 69, 75 , scalp pain (n=2) 13, 67 , neck pain (n=2) 70 , restlessness (n=1) 77 , and sleepiness (n=1) 14 . Moderate adverse events include generalized tonic-clonic seizure (n=3) 65, 68, 72 and rapid moodswings (n=1) 77 .…”

Section: Resultsmentioning

confidence: 99%

Safety of Transcranial Magnetic Stimulation in Children: A Systematic Review of the Literature

Allen

Kluger

Buard

2017

Pediatric Neurology

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Context Data and best practice recommendations for transcranial magnetic stimulation (TMS) use in adults is largely available. While there is less data in pediatric populations and no published guidelines, its practice in children continues to grow. Methods We performed a literature search through PubMed to review all TMS studies from 1985-2016 involving children and documented any adverse events. Crude risks were calculated per session. Results Following data screening, we identified 42 single pulse (spTMS) and/or paired pulse (ppTMS) TMS studies involving 639 healthy children (HC), 482 children with CNS disorders, and 84 epileptic children (EP). Adverse events (AEs) occurred at rates of 3.42%, 5.97%, and 4.55% respective to population and number of sessions. We also report 23 repetitive TMS (rTMS) studies involving 230 CNS and 24 EP with AE rates of 3.78% and 0.0% respectively. We finally identified three theta-burst stimulation (TBS) studies involving 90 HC, 40 CNS and no EP, with AE rates of 9.78% and 10.11% respectively. Three seizures were found to have occurred in CNS individuals during rTMS, with a risk of 0.14% per session. There was no significant difference in frequency of AEs by group (p = .988) nor modality (p = .928). Conclusions Available data suggests that risk from TMS/TBS in children is similar to adults. We recommend that TMS users in this population follow the most recent adult safety guidelines until sufficient data are available for pediatric specific guidelines. We also encourage continued surveillance through surveys and assessments on a session-basis.

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Section: Resultsmentioning

confidence: 99%

Safety of Transcranial Magnetic Stimulation in Children: A Systematic Review of the Literature

Allen

Kluger

Buard

2017

Pediatric Neurology

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“…4,40,41 These findings may have a bearing on the applicability of therapies such as transcranial magnetic stimulation, constraintinduced movement therapy, which are widely used in the rehabilitation of stroke [42][43][44] and cerebral palsy. [45][46][47] Some studies even indicate the possibility of using the EEG as a central nervous system dysfunctions marker. [48][49][50][51] As an example, the specific measurements derived from an electroencephalogram could indicate cortical areas most affected in cases of traumatic brain injury, and may thus be useful for the development of tools for its diagnosis.…”

Section: ■ Discussionmentioning

confidence: 99%

Gamma absolute power reveals activation of motor areas after hand immobilization

Machado¹,

França²,

Teixeira³

et al. 2016

Medical Express

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OBJECTIVE:To analyze changes in gamma band absolute power in motor cortical areas, before and after a condition of hand immobilization for 48 hours. METHOD: Fifteen healthy volunteers, aged between 20 and 30, were submitted to EEG assessment before and after 48 hours of immobilization of the dominant hand, while performing a motor task triggered by a visual stimulus. A two-way repeated measures ANOVA with two within-group factors (moment x condition), each one with two levels (before vs. after visual stimuli; before vs. after 48-hour HI, respectively) was used to test for changes in beta band absolute power. RESULTS: Statistical analysis revealed that hand immobilization caused changes in cortical areas. A significant increase in gamma band absolute power was found after hand immobilization at electrodes F3 (p = 0.001) at F4 (p = 0.001) and at Fz (p = 0.001), at C3 (p = 0.001), C4 (p = 0.001) and Cz (p = 0.001). CONCLUSION: These results reveal that oscillations of the gamma band can be a cortical strategy to solve the effect of less activation due to movement restriction. Knowledge of the functioning of motor cortical areas after a condition of immobilization can lead to more effective strategies in rehabilitation.

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“…Myelination is ongoing during this refinement process. 10,11 Ipsilateral and contralateral axonal projections present at birth begin to progressively withdraw in response to activity-dependent competition, with the contralateral projections becoming more dominant. 10,12 This developmental process has been revealed using transcranial magnetic stimulation (TMS) in a study by Eyre et al, 13 who found evidence of progressively weakening ipsilateral motor responses in infants by 6 months of age.…”

Section: Introductionmentioning

confidence: 99%

“…The use of TMS to examine and modulate corticomotor excitability in children with hemiparetic CP has been conducted without serious adverse events, such as seizure. 11, 16–18 Some studies reported mild adverse events, such as dizziness and fatigue. 17 Corticomotor excitability assessment using TMS has been conducted on infant populations and has provided information regarding early brain development.…”

Section: Introductionmentioning

confidence: 99%

Understanding Brain Reorganization in Infants With Perinatal Stroke Through Neuroexcitability and Neuroimaging

Chen

Georgieff

Elison

et al. 2017

Pediatric Physical Therapy

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Purpose The primary aim of this proposed study is to evaluate brain reorganization patterns in infants with perinatal stroke between 3 and 5 months of age using transcranial magnetic stimulation and magnetic resonance imaging, with the addition of the General Movements Assessment. A secondary aim is to demonstrate feasibility and safety of infant-appropriate brain assessment protocols. Methods Ten infants with perinatal stroke will be enrolled. In this exploratory study, infants will first receive magnetic resonance imaging scanning during natural sleep to examine their corticospinal tract integrity. Infants will then receive transcranial magnetic stimulation to assess their corticomotor excitability. A General Movements Assessment video of at least 5 minutes will also be recorded. Discussion Study results will enhance our understanding of brain reorganization in infants with perinatal stroke. We expect these results will also guide the development of early interventions designed to mitigate maladaptive neuroplastic changes and improve long-term motor outcomes.

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Brain stimulation and constraint for perinatal stroke hemiparesis

Abstract: This study provides Class II evidence that combined rTMS and CIMT enhance therapy-induced functional motor gains in children with stroke-induced hemiparetic cerebral palsy.

Cited by 108 publications

References 34 publications

Safety of Transcranial Magnetic Stimulation in Children: A Systematic Review of the Literature

Safety of Transcranial Magnetic Stimulation in Children: A Systematic Review of the Literature

Gamma absolute power reveals activation of motor areas after hand immobilization

Understanding Brain Reorganization in Infants With Perinatal Stroke Through Neuroexcitability and Neuroimaging

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