Transcranial Magnetic Stimulation Therapy in Spastic Cerebral Palsy Children Improves Motor Activity

Gupta, Meena; Rajak, Bablu Lal; Bhatia, Dinesh; Mukherjee, Arun

doi:10.4172/2314-7326.1000231

Cited by 10 publications

(6 citation statements)

References 21 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…The rTMS frequency of 10 Hz and pulse train of 2500 was kept constant after establishing their stimulating effect published in our previous communicated studies. [1619] Participants in S-20, S-30, and S-40 were provided 20, 30, and 40 sessions of rTMS therapy, respectively. Each rTMS session was of 25-min duration and was administered once daily for 5 days a week for 4 weeks to S-20 group, for 6 weeks to S-30 group, and for 8 weeks to S-40 group.…”

Section: Methodsmentioning

confidence: 99%

“…[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.…”

Section: Introductionmentioning

confidence: 99%

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

Rajak¹,

Gupta²,

Bhatia³

et al. 2019

Ann Indian Acad Neurol

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Background: Repetitive TMS (rTMS), a non-invasive neuro-stimulation tool based on the principle of electromagnetic induction is recently being employed both for investigational and interventional purposes. The stimulating effect of rTMS on motor cortex areas of the brain leads to increased motor activity and decreased muscle tone in spastic cerebral palsy (CP) patients. Objective: This modulatory effect of rTMS is used in this study to evaluate its effect on motor function and spasticity by increasing the number of therapy session and keeping frequency of 10Hz and pulse train of 2500 constant. Methods: Total thirty spastic CP patients participated in this study after written informed consent from their parents/guardians. The participants were equally divided into three groups, namely, S-20, S-30 and S-40 depending on the number of therapy sessions. The mean age±SD of participants in different groups were 8.9±3.6, 9.5±2.9 and 8.4±3.5 in S-20, S-30 and S-40 respectively. Participants in S-20, S-30 and S-40 were provided 20, 30 and 40 sessions of rTMS therapy respectively followed by physical therapy of 30 minutes daily. Each rTMS session was of 25 minutes duration and was administered once daily for 5 days a week. Prior to start and after completion of the therapy, pre and post assessment of gross motor function measure (GMFM) for motor function and modified Ashworth scale (MAS) for muscle spasticity was performed on all the participants. Outcomes: The result of pre-versus-post GMFM score showed that 4.27%, 3.12% and 2.36% motor gain was obtained after 40, 30 and 20 sessions of therapy respectively. In addition, significant reduction in spasticity in both upper and limb muscles was also observed in all the three groups.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Rajak¹,

Gupta²,

Bhatia³

et al. 2019

Ann Indian Acad Neurol

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Rajak¹,

Gupta²,

Bhatia³

et al. 2017

J Neurol Disord

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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).

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“…Several studies reported that rTMS had positive effects on treating patients with depression, Parkinson's disease, Huntington's disease, dystonia and cerebral palsy [13][14][15][16]. Recently, rTMS has been used in post-stroke care [17,18].…”

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confidence: 99%

The Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Functional Indices of Affected Upper Limb in Patients with Subacute Stroke

et al. 2018

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Background: Repetitive transcranial magnetic stimulation (rTMS) is a novel technique that may improve recovery in patients with stoke, but the role of rTMS as an applied and practical treatment modality for stroke rehabilitation has not been established yet.Objective: This study was conducted to determine the effects of a rehabilitation program (RP) in conjunction with rTMS on functional indices of the paretic upper limb in the subacute phase of stroke.Material and Methods: Twenty patients in the subacute phase of stroke were randomly assigned into two groups: The high frequency rTMS (HF-rTMS) in conjunction with RP (experimental group), and the RP group (control group). The experimental group received 10 sessions of 20 Hz rTMS on the affected primary motor cortex and the other group received 10 sessions of RP. In experimental group, RP for the paretic hand was conducted following rTMS session. Box and block test (BBT), Fugl-Meyer Motor Assessment for upper limb (FMA-UL), grip strength and pinch strength were used to assess motor function before the first session and after the last session of treatment.Results: Significant improvement in BBT, FMA-UL, grip strength and pinch strength was observed in both groups. Improvement of BBT and grip strength was significantly greater in the experimental group rather than the control group (p<0.05). FMA-UL score and the pinch strength were greater in the experimental group, although the differences were not statistically significant. Conclusion: HF-rTMS in conjunction with RP is effective to improve the function of upper limb. It seems HF-rTMS is a novel feasible and safe technique for hemiparesis patients in the subacute phase of stroke.

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Transcranial Magnetic Stimulation Therapy in Spastic Cerebral Palsy Children Improves Motor Activity

Cited by 10 publications

References 21 publications

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

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

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

The Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Functional Indices of Affected Upper Limb in Patients with Subacute Stroke

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