Abstract
Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) applied to the non-lesional hemisphere is reported to significantly improve motor function of the affected upper limb in adult stroke patients with hemiparesis. For pediatric stroke patients, the beneficial effects of LF-rTMS have been already confirmed in a randomized controlled study. However, there is no report of therapeutic application of high-frequency rTMS (HF-rTMS) in this patient population. In this case series study, we introduced HF-rTMS combined with intensive occupational therapy (OT) in two pediatric hemiparetic patients. We studied two children (8- and 9-year-old boys, both right-handed) with post-stroke upper limb hemiparesis (chronic phase). Both patients underwent 22 treatment sessions of HF-rTMS/OT during 15-day hospitalization. The HF-rTMS was applied over the lesional motor cortex at a frequency of 10Hz for 15 minutes in each session. One session of intensive OT consisted of 30-min one-to-one training and 30-min self-exercise. Motor function of the affected upper limb was serially evaluated with Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Simple Test for Evaluating hand Function (STEF), and Ten-second Test. Neither of the patients showed any adverse effects. Both patients showed improvement of motor function in the affected upper limb and were able to use the affected upper limb in some activities of daily living. In the two post-stroke pediatric patients, HF-rTMS/OT was safe and improved upper limb muscle function. Confirmation of these effects in a larger population is needed.
Highlights
Pediatric stroke is not a common disease compared with adult stroke
The optimal site of stimulation on the scalp was defined as the location where the largest motor evoked potentials (MEPs) in the first dorsal interosseous (FDI) muscle of the affected upper limb was elicited on the surface electromyogram
The score of Simple Test for Evaluating hand Function (STEF) and the sum of function ability score (FAS) on Wolf Motor Function Test (WMFT) increased in both patients
Summary
Pediatric stroke is not a common disease compared with adult stroke. The annual incidence rate of pediatric stroke is estimated to be 2.4/100,000 in the United States [1]. While the leading cause of adult stroke is arteriosclerosis, the underlying causes of pediatric stroke relate to rare congenital abnormalities manifested as cardiovascular disorders, prothrombotic disorders, arteriopathies and cerebral arterial abnormalities rather than aging [2]. It seems that the diagnosis and treatment of pediatric stroke is often delayed, due to the uncommonness of the condition [3]. Motor impairment after stroke can be expected to recover more significantly in pediatric than in adult patients due to differences in neuroplasticity, no effective therapy for poststroke hemiparesis in pediatrics is available at present
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