Abstract
Muscle spasticity is a disability caused by damage to the pyramidal system. Standard treatments for spasticity include muscle stretching, antispastic medications, and tendon release surgeries, but treatment outcomes remain unsatisfactory. Anodal transcranial direct current stimulation (tDCS) in patients with muscle spasticity is known to result in significant improvement in spastic tone (p < 0.001). However, the mechanism of action by which tDCS treatment affects spasticity remains unclear. This pilot study aimed to investigate the effect of anodal tDCS upon brain metabolites in the left basal ganglia and ipsilateral primary motor cortex (M1) in children with spastic cerebral palsy (CP). This study consisted of three steps: a baseline evaluation, a treatment period, and a follow-up period. During the treatment period, patients were given 20 min of 1 mA anodal tDCS over the left M1 for five consecutive days. Outcomes were compared between pre- and immediate posttreatment in terms of brain metabolites, Tardieu scales, and the quality of upper extremity skills test. Ten patients with spastic CP were enrolled. Following tDCS, there were significant increases in the ratio of N-acetylaspartate (NAA)/creatine (Cr) (p = 0.030), choline (Cho)/Cr (p = 0.043), and myoinositol (mI)/Cr (p = 0.035) in the basal ganglia. Moreover, increased glutamine-glutamate (Glx)/Cr ratio in the left M1 (p = 0.008) was found. In addition, we also observed improvements in the extent of spasticity and hand function (p = 0.028). Five consecutive days of anodal tDCS over the left M1 appeared statistically to reduce the degree of spasticity and increase NAA, Cho, mI, and Glx. Future research studies, involving a larger sample size of spastic CP patients undergoing tDCS is now warranted.
Highlights
Muscle spasticity is a sign of an upper motor neuron deficit caused by damage to the pyramidal system; this reduces cortical input to the corticospinal tract, resulting in the disinhibition of spinal segmental excitability and an increase in muscle tone (1)
the first study to describe the changes in brain metabolite concentrations
which occur after 1 mA
Summary
Muscle spasticity is a sign of an upper motor neuron deficit caused by damage to the pyramidal system; this reduces cortical input to the corticospinal tract, resulting in the disinhibition of spinal segmental excitability and an increase in muscle tone (1). Previous research studies have demonstrated the effects of anodal transcranial direct current stimulation (tDCS) upon motor function of the upper (2) and lower limbs (3–5) in patients with spastic cerebral palsy (CP). Our previous study found that anodal tDCS can reduce upper limb spasticity and increase the range of motion in children with spastic CP (2) These earlier results illustrated statistically significant differences in Ashworth scores between groups after immediate posttreatment, and this improvement in spasticity was maintained for at least 48 h (2). The mechanism of action by which tDCS treatment affects spasticity remains unclear This pilot study aimed to investigate the effect of anodal tDCS upon brain metabolites in the left basal ganglia and ipsilateral primary motor cortex (M1) in children with spastic cerebral palsy (CP)
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