Non-Invasive Brain Stimulation in Children With Unilateral Cerebral Palsy: A Protocol and Risk Mitigation Guide

Gillick, Bernadette T.; Gordon, Andrew M.; Feyma, Tim; Krach, Linda E.; Carmel, Jason B.; Rich, Tonya L.; Bleyenheuft, Yannick; Friel, Kathleen M.

doi:10.3389/fped.2018.00056

Cited by 25 publications

(25 citation statements)

References 87 publications

(73 reference statements)

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“…In this regard, another major limitation of the present study is the absence of the assessment of the neurophysiological status of our UCP participants, which precluded the evaluation of tDCS effects on cortical responses, as well as of the relationship between tDCS-induced behavioral gains and underlying neurophysiology. In the developing brain with neurologic injury, motor outcomes and tDCS effects are both related to differences in the corticospinal circuitry [15, 26, 46]. Finally, the development of specific guidelines for the application of tDCS in the pediatric population could facilitate recruitment and standardization on the use and management of tDCS [44] and potentially lead to a greater role as a therapeutic tool for neurodevelopmental rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Transcranial Direct Current Stimulation (tDCS) in Unilateral Cerebral Palsy: A Pilot Study of Motor Effect

et al. 2019

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Transcranial Direct Current Stimulation (tDCS) is an emerging tool to improve upper limb motor functions after stroke acquired in adulthood; however, there is a paucity of reports on its efficacy for upper limb motor rehabilitation in congenital or early-acquired stroke. In this pilot study we have explored, for the first time, the immediate effects, and their short-term persistence, of a single application of anodal tDCS on chronic upper limb motor disorders in children and young individuals with Unilateral Cerebral Palsy (UCP). To this aim, in a crossover sham-controlled study, eight subjects aged 10-28 years with UCP underwent two sessions of active and sham tDCS. Anodal tDCS (1.5 mA, 20 min) was delivered over the primary motor cortex (M1) of the ipsilesional hemisphere. Results showed, only following the active stimulation, an immediate improvement in unimanual gross motor dexterity of hemiplegic, but not of nonhemiplegic, hand in Box and Block test (BBT). Such improvement remained stable for at least 90 minutes. Performance of both hands in Hand Grip Strength test was not modified by anodal tDCS. Improvement in BBT was unrelated to participants' age or lesion size, as revealed by MRI data analysis. No serious adverse effects occurred after tDCS; some mild and transient side effects (e.g., headache, tingling, and itchiness) were reported in a limited number of cases. This study provides an innovative contribution to scientific literature on the efficacy and safety of anodal tDCS in UCP. This trial is registered with NCT03137940.

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Section: Discussionmentioning

confidence: 99%

Transcranial Direct Current Stimulation (tDCS) in Unilateral Cerebral Palsy: A Pilot Study of Motor Effect

et al. 2019

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“…Those participants who responded affirmatively via email were subsequently contacted via telephone and asked to respond to 20 questions regarding their subjective assessment of their current neurological health (see Supplementary Material for questionnaire). This questionnaire is a variant of the Participant Report of Symptoms questionnaire that has previously been used in other non-invasive neuromodulation studies 45,46 . If there was a positive response to a question indicating perceived experience of the symptom, participants were then asked to rank the symptom severity from 2-4 (1 = absent) where 2 = mild, 3 = moderate and 4 = severe.…”

Section: Methodsmentioning

confidence: 99%

“…It is the purpose of this paper to provide an initial assessment of the symptoms and minor adverse events and safety of single element focused ultrasound for human neuromodulation as there is little research on participant perceived tolerance and report of symptoms. Here, we report on the findings of a variant of the Participant Report of Symptoms questionnaire 45,46 assessing participants' perceived tolerance to participation in LIFU and their perceived relation of any symptoms to the ultrasound intervention. Of a group of 120 queried, a total of (N = 64) consented to completing the questionnaire at various time points from immediately post-experiment out to 22 months.…”

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confidence: 99%

A retrospective qualitative report of symptoms and safety from transcranial focused ultrasound for neuromodulation in humans

Legon

Adams

Bansal

et al. 2020

Sci Rep

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Low intensity transcranial focused ultrasound (LifU) is a promising method of non-invasive neuromodulation that uses mechanical energy to affect neuronal excitability. LIFU confers high spatial resolution and adjustable focal lengths for precise neuromodulation of discrete regions in the human brain. Before the full potential of low intensity ultrasound for research and clinical application can be investigated, data on the safety of this technique is indicated. Here, we provide an evaluation of the safety of LifU for human neuromodulation through participant report and neurological assessment with a comparison of symptomology to other forms of non-invasive brain stimulation. participants (n = 120) that were enrolled in one of seven human ultrasound neuromodulation studies in one laboratory at the University of Minnesota (2015-2017) were queried to complete a follow-up Participant Report of Symptoms questionnaire assessing their self-reported experience and tolerance to participation in LifU research (i sppa 11.56-17.12 W/cm 2) and the perceived relation of symptoms to LIFU. A total of 64/120 participant (53%) responded to follow-up requests to complete the Participant Report of Symptoms questionnaire. None of the participants experienced serious adverse effects. From the post-hoc assessment of safety using the questionnaire, 7/64 reported mild to moderate symptoms, that were perceived as 'possibly' or 'probably' related to participation in LIFU experiments. These reports included neck pain, problems with attention, muscle twitches and anxiety. The most common unrelated symptoms included sleepiness and neck pain. There were initial transient reports of mild neck pain, scalp tingling and headache that were extinguished upon follow-up. No new symptoms were reported upon follow up out to 1 month. The profile and incidence of symptoms looks to be similar to other forms of non-invasive brain stimulation. Transcranial focused ultrasound (LIFU) is a new and promising non-surgical low-energy technique that uses mechanical energy to modulate neuronal activity with high spatial resolution and adjustable depth of focus. LIFU has been used safely and effectively for cortical and sub-cortical neuromodulation in mouse 1-4 , rat 5-7 , rabbit 8 , sheep 9,10 , pig 11 and primate 12-15 , and has also been demonstrated to be an effective method of transient cortical and sub-cortical neuromodulation in humans 16,17. In humans, LIFU has been applied to the temporal cortex 18 , primary somatosensory cortex (S1) 16,19 , secondary somatosensory cortex (S2) 20 , primary motor cortex 21 , primary visual cortex 22 and thalamus 17,23. LIFU has been shown to affect the amplitude of evoked potentials 8,16,19 , the power, phase and frequency of the electroencephalogram (EEG) 16,24 ; the blood oxygen level dependent (BOLD) magnetic resonance imaging signal 8,25,26 , as well as tactile 16,19 and reaction time 21 behavior. As currently employed, human neuromodulation with LIFU typically involves coupling one (or more than one 20) focused single-el...

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“…However, although there has been considerable investigation of the effectiveness of tDCS for adult stroke, the findings cannot be assumed to translate directly into children and adolescents with CP, due to differences in brain size, maturity, anatomy and reorganisation. The application of tDCS in this population appears to be safe [4] and safety guidelines have been developed [5]. This narrative review therefore focuses on the neurophysiological and clinical findings with use of tDCS in children and adolescents (6–21 years) with CP.…”

Section: Introductionmentioning

confidence: 99%

Transcranial direct current stimulation for promoting motor function in cerebral palsy: a review

Fleming

Theologis

Buckingham

et al. 2018

J NeuroEngineering Rehabil

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Transcranial direct current stimulation (tDCS) has the potential to improve motor function in a range of neurological conditions, including Cerebral Palsy (CP). Although there have been many studies assessing tDCS in adult stroke, the literature regarding the efficacy of tDCS in CP is more limited. This review therefore focuses on the neurophysiological and clinical findings in children and adolescents with CP. Initial studies applying anodal tDCS to promote lower limb function are promising, with improvements in gait, mobility and balance reported. However, the results of upper limb studies are mixed and more research is needed. Studies investigating neurophysiological changes or predictors of response are also lacking. Large-scale longitudinal studies are needed for the lower limb to ascertain whether the initial pilot results translate into clinically meaningful improvements. Future studies of the upper limb should focus on determining the optimal stimulation parameters and consider tailoring stimulation to the individual based on the (re)organisation of their motor system.

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Non-Invasive Brain Stimulation in Children With Unilateral Cerebral Palsy: A Protocol and Risk Mitigation Guide

Cited by 25 publications

References 87 publications

Transcranial Direct Current Stimulation (tDCS) in Unilateral Cerebral Palsy: A Pilot Study of Motor Effect

Transcranial Direct Current Stimulation (tDCS) in Unilateral Cerebral Palsy: A Pilot Study of Motor Effect

A retrospective qualitative report of symptoms and safety from transcranial focused ultrasound for neuromodulation in humans

Transcranial direct current stimulation for promoting motor function in cerebral palsy: a review

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