Transcranial direct current stimulation for children with perinatal stroke and hemiparesis

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AHAAssisting Hand Assessment MEP Motor evoked potential PedsQL Pediatric Quality of Life Inventory Version 3.0 RMT Resting motor threshold TMS Transcranial magnetic stimulation AIM To characterize fatigue in children with hemiparesis with perinatal stroke and explore associations with measures of motor performance and corticospinal excitability. METHOD Forty-five children (16 females, 29 males), aged 6 to 18 years (mean [SD] 12y [4]), with magnetic resonance imaging-confirmed perinatal stroke participated. Associations between fatigue (Pediatric Quality of Life Inventory Version 3.0 cerebral palsy module fatigue subscale), motor performance (Assisting Hand Assessment [AHA], Box and Blocks Test, grip strength), and excitability of corticospinal projections to both hands were examined using ranked tests of correlation, robust regression, and the Mann-Whitney U test.RESULTS Nearly half of the participants (n=21) reported experiencing fatigue in the previous month. Function in the less affected hand (Box and Blocks Test, grip strength) was correlated with fatigue scores. Participants with preserved ipsilateral projections to the more affected hand had less fatigue, and scores correlated with the excitability of these projections. Fatigue scores were not associated with age, sex, or AHA score.INTERPRETATION Fatigue is common in children with hemiparesis with perinatal stroke and is associated with motor performance and the presence and excitability of ipsilateral corticospinal projections from the contralesional hemisphere to the more affected hand.

Section: Discussionmentioning

confidence: 99%

Fatigue in children with perinatal stroke: clinical and neurophysiological associations

Wrightson

Zewdie

Kuo

et al. 2019

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“…Imaging and brain stimulation can map this complex neurophysiology in vivo, validating the model in real patients . Such modeling has direct implications for emerging treatment modalities including constraint‐induced movement therapy and non‐invasive brain stimulation but is both cumbersome and expensive. A clinical assessment that could assess this motor organization at the bedside could be a useful tool for implementing more personalized approaches to neurorehabilitation.…”

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confidence: 99%

Mirror movements in children with unilateral cerebral palsy due to perinatal stroke: clinical correlates of plasticity reorganization

Riddell

Kuo

Zewdie

et al. 2019

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Aim We aimed to determine if the mirror movements that often result in children with unilateral cerebral palsy (CP) after perinatal stroke represent a clinical biomarker of developmental plasticity. Method This was a prospective, controlled cohort study. Mirror movements in children with unilateral CP from a population‐based cohort were compared to those of typically developing controls. The population with stroke was assessed further via electromyography (EMG), motor function, and corticospinal organization investigations. Mirror movements were quantified (0–5) bidirectionally. EMG mirror movements were quantified during voluntary contraction. Motor function was quantified by validated measures including the Assisting Hand Assessment (AHA). Corticospinal organization was categorized as ipsilateral or contralateral using transcranial magnetic stimulation (TMS). The relationships between mirror movements, function, and corticospinal organization were assessed (t‐tests, Pearson rank correlation coefficients). Results Ninety‐two participants were scored (55 males, 37 females, mean [SD] 12y [5y 6mo], range 4–17y), 63 with complete motor outcomes and 39 with TMS data. EMG ratios correlated with clinical mirror movements (r=0.562, p=0.008). Mild mirror activity in controls declined with age (r=−0.459, p<0.001). Mirroring was stronger with tasks performed by the affected hand (p<0.001). Mirror movements correlated with AHA scores (r=−0.255, p=0.04) and poor motor outcome (p<0.001). Unaffected hand mirror activity was higher in children with ipsilateral corticospinal tract arrangements (p<0.001). Interpretation Clinical mirror movements correlate with disability and corticospinal organization in children with unilateral CP with perinatal stroke. This simple bedside biomarker could facilitate patient selection for personalized rehabilitation. What this paper adds Mirror movements are a clinical indicator of corticospinal organization in children with unilateral cerebral palsy with perinatal stroke. Mirroring is strongest in children with ipsilateral corticospinal tract reorganization. The concept of a ‘directionality factor’ to mirror movements highlights additional, clinically relevant functional correlations.

“…the corpus callosum) remains an understudied element of such models. The same models have also recently been translated in positive neuromodulation clinical trials, suggesting high translational relevance . NAIS represents ‘an ideal human model’ for understanding developmental motor plasticity .…”

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confidence: 99%

“…NAIS represents ‘an ideal human model’ for understanding developmental motor plasticity . Having more mechanistic studies on how the two motor cortices structurally interact could add more knowledge on how to design ‘advance personalized’ neuromodulation therapies for children having suffered from NAIS …”

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confidence: 99%

Association of transcallosal motor fibres with function of both hands after unilateral neonatal arterial ischemic stroke

Groeschel¹,

Hertz‐Pannier

Delion

et al. 2017

Compared to typically developing children, children after NAIS exhibited a smaller motor part of their corpus callosum associated with reduced contralesional but also ipsilesional manual dexterity. These results indicate that the affection of transcallosal motor fibres in unilateral NAIS might be of functional relevance and an important part of the involved structural network that should be elucidated in further studies.