Abstract
Combined non-invasive brain stimulation (NIBS) and rehabilitation interventions have the potential to improve function in children with unilateral cerebral palsy (UCP), however their effects on developing brain function are not well understood. In a proof-of-principle study, we used single-pulse transcranial magnetic stimulation (TMS) to measure changes in corticospinal excitability and relationships to motor performance following a randomized controlled trial consisting of 10 days of combined constraint-induced movement therapy (CIMT) and cathodal transcranial direct current stimulation (tDCS) applied to the contralesional motor cortex. Twenty children and young adults (mean age = 12 years, 9 months, range = 7 years, 7 months, 21 years, 7 months) with UCP participated. TMS testing was performed before, after, and 6 months after the intervention to measure motor evoked potential (MEP) amplitude and cortical silent period (CSP) duration. The association between neurophysiologic and motor outcomes and differences in excitability between hemispheres were examined. Contralesional MEP amplitude decreased as hypothesized in five of five participants receiving active tDCS immediately after and 6 months after the intervention, however no statistically significant differences between intervention groups were noted for MEP amplitude [mean difference = −323.9 μV, 95% CI = (−989, 341), p = 0.34] or CSP duration [mean difference = 3.9 ms, 95% CI = (−7.7, 15.5), p = 0.51]. Changes in corticospinal excitability were not statistically associated with improvements in hand function after the intervention. Across all participants, MEP amplitudes measured in the more-affected hand from both contralesional (mean difference = −474.5 μV) and ipsilesional hemispheres (−624.5 μV) were smaller compared to the less-affected hand. Assessing neurophysiologic changes after tDCS in children with UCP provides an understanding of long-term effects on brain excitability to help determine its potential as a therapeutic intervention. Additional investigation into the neurophysiologic effects of tDCS in larger samples of children with UCP are needed to confirm these findings.
Highlights
Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation, can be used to modulate corticospinal excitability and produce changes in motor function (Peters et al, 2016)
To advance the application of combined neuromodulatory and motor training interventions in children with unilateral cerebral palsy (UCP), we examined corticospinal excitability before and after a randomized, sham-controlled clinical trial consisting of combined transcranial direct current stimulation (tDCS) concurrent with a behavioral intervention
Only contralesional primary motor cortex (M1) motor evoked potential (MEP) amplitude was significantly greater in the Active+constraint-induced movement therapy (CIMT) group at Pre-test (p = 0.04)
Summary
Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS), can be used to modulate corticospinal excitability and produce changes in motor function (Peters et al, 2016). There is evidence supporting anodal and cathodal tDCS, when paired with other motor training interventions, in adult stroke. Cathodal contralesional tDCS is hypothesized to reduce exaggerated IHI, potentially increasing excitability in the ipsilesional hemisphere following stroke. This hypothesis is supported by existing studies in adults with stroke demonstrating that cathodal contralesional tDCS augments the effects of intensive motor training compared to training alone (Bolognini et al, 2011; Nair et al, 2011; Figlewski et al, 2017)
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