OP29 – 2815: Brain stimulation and constraint for perinatal stroke hemiparesis: The PLASTIC CHAMPS trial

Abstract

Objective Perinatal stroke causes hemiparetic cerebral palsy and lifelong disability. Constraint-induced movement therapy (CIMT) can improve motor function in congenital hemiparesis and adult stroke. Repetitive transcranial magnetic stimulation (rTMS) may improve motor function in adult stroke. The two have not been formally tested in perinatal stroke hemiparesis. Methods PLASTIC CHAMPS ( www.clinicaltrials.gov/NCT01189058 ) was a blinded, controlled, factorial trial of rTMS and CIMT in perinatal stroke hemiparesis. Children 6–18 years participated in a 2 week, goal-directed, peer-supported, motor learning camp. Subjects were randomized to daily inhibitory rTMS (1Hz, 1200 stimulations) over contralesional primary motor cortex, CIMT, both or neither. Primary outcomes were the Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM) at 1 week, 2 months, and 6 months. Additional outcomes included the Melbourne Assessment, quality-of-life, safety and tolerability. Corticospinal tract arrangement was defined using single-pulse TMS. Intent-to-treat analysis assessed change across treatment groups over time (ANOVA, linear mixed effects model). Results All forty-five children completed the trial (median 11.4 years). Across all subjects, COPM performance and satisfaction scores increased >100% with sustained, maximal gains at 6 months (p 5 logit units). Combined rTMS+CIMT resulted in larger AHA gains at all time points (6 months p=0.006). CIMT alone increased AHA at 2 months (p=0.007), rTMS alone increased AHA at 1 week (p=0.002). Neither treatment decreased unaffected hand function. Affected hand function did not decrease with rTMS in children with ipsilateral corticospinal tract arrangements. Procedures were well tolerated. Conclusion Children with hemiparesis participating in intensive, psychosocial rehabilitation programs perceive marked and sustained increases in goal-specific function. Non-invasive brain stimulation trials are feasible in children with CP. Contralesional inhibitory rTMS may enhance motor learning therapy in children with perinatal stroke.