Magnetic Stimulation In Children Research Articles

Therapeutic effects of repetitive transcranial magnetic stimulation in patients with cerebral palsy: a systematic review and network meta-analysis.

The purpose of this study was to systematically evaluate the efficacy of repetitive transcranial magnetic stimulation in children with cerebral palsy and to compare the differences in efficacy of different treatment parameters. Computer searches of PubMed, Embase, Cochrane Library, Scopus, Web of Science, China Knowledge Network, Wanfang Data Knowledge Service Platform, Vipshop and China Biomedical Literature Database were conducted to collect randomized controlled trials (RCTs) of TMS to improve function in children with cerebral palsy. The search period was from the establishment of the database to April 2023. Two researchers independently screened the literature and extracted data information, and the risk of bias was assessed for the included studies using the Cochrane Systematic Evaluation Manual 5.1.0. Statistical analysis was performed using RevMan 5.4 and Stata software. A total of 18 studies containing 1675 patients with cerebral palsy were included, and r-TMS did not differ significantly from other treatments in improving language function [MD = 2.80, 95% CI (-1.51, 7.11), Z = 1.27, P = 0.20] after treatment. The results of the reticulated meta-analysis showed the best probability ranking of the effect of three different frequencies of r-TMS on motor function scores in children with cerebral palsy: combined LF-rTMS + HF-rTMS (49.8%) > LF-rTMS (45.6%) > HF-rTMS (4.6%) > conventional rehabilitation (0%). Publication bias showed no significant asymmetry in the inverted funnel plot, but the possibility of publication bias could not be excluded. The results of this study showed that r-TMS was not statistically significant in improving language function in children with cerebral palsy compared to conventional treatment. r-TMS was almost unanimously significantly effective in motor function in children with cerebral palsy according to current literature data, and the combined high- and low-frequency transcranial magnetic therapy was better than low-frequency transcranial magnetic therapy.

Transcranial Magnetic Stimulation Application in Children with Severe Traumatic Brain Injury: a Randomized Prospective Study

INTRODUCTION. Today, severe traumatic brain injury (STBI) poses a serious threat to the life and health of affected children, which requires long-term expensive treatment and long-term rehabilitation. Improving the diagnosis, resuscitation and neurosurgical care for children with STBI leads to an increase in the percentage of surviving patients, which necessitates the development and implementation of individual early rehabilitation programs. One of the tasks of early rehabilitation is to reduce the spasticity of the extremities, in connection with which transcranial magnetic stimulation (TMS) is used in our hospital. The experience of using the TCMS method in the first month of STBI in children is given, due to which the dynamics of the restoration of lost functions improves.
 AIM. Evaluation of the effectiveness of the use of the method of transcranial magnetic stimulation in children in the acute period of STBI with inclusion in the program of early medical rehabilitation.
 MATERIAL AND METHODS. 40 patients with STBI who were treated at the GAUZ СRCH MH RT, Kazan were taken for curation. The main group was selected by the randomization method, which included 20 (50 %) patients who received the procedure of transcranial magnetic stimulation in the individual program of medical rehabilitation and the control group — 20 (50 %) patients who received only the standard individual program of early rehabilitation. Patients of the main group on the 10th day after receiving a severe traumatic brain injury were initiated to undergo TKMS in addition to the program of individual early rehabilitation.
 RESULTS AND DISCUSSION. As a result of the course of therapy with the inclusion of TMS in the rehabilitation measures, an increase in the motor activity of the affected limb was observed, which led to an improvement in the patient’s self-care.
 CONCLUSION. The inclusion of transcranial magnetic stimulation in the program of early rehabilitation of children with severe traumatic brain injury creates suitable conditions for the course of compensatory-regenerative processes in the brain due to the depolarization of the membrane of cortical neurons. In this group of patients, there was a clear increase in muscle strength and a decrease in spasticity.

Shortened Motor Evoked Potential Latency in the Epileptic Hemisphere of Children With Focal Epilepsy.

Motor evoked potential (MEP) amplitude and latency are acquired routinely during neuronavigated transcranial magnetic stimulation, a method of functional mapping of the motor cortex before epilepsy surgery. Although MEP amplitude is routinely used to generate a motor map, MEP latency in patients with focal epilepsy has not been studied systematically. Given that epilepsy may alter myelination, we tested whether intrinsic hand muscle MEPs obtained from the hemisphere containing a seizure focus differ in latency from MEPs collected from the opposite hemisphere. Latencies of abductor pollicis brevis MEPs were obtained during routine motor mapping by neuronavigated transcranial magnetic stimulation in children with intractable, unihemispheric focal epilepsy. The primary motor cortex was stimulated bilaterally in all cases. Only data from patients without a lesion involving the corticospinal tract were included. We tested whether abductor pollicis brevis MEP latency varied as a function of seizure focus lateralization. In the 17 patients who met the inclusion criteria, the mean latency of MEPs with amplitudes in the top and bottom quartiles was shorter in the epileptic hemisphere. Interhemispheric latency difference was greater in patients with lesional epilepsy than in those with nonlesional epilepsy (0.7 ± 0.4 vs. 0.1 ± 0.6 milliseconds, P = 0.02). Motor evoked potential latency was shortened in the epileptic hemisphere of children with focal epilepsy.

Outcomes from Individual Alpha Frequency Guided Repetitive Transcranial Magnetic Stimulation in Children with Autism Spectrum Disorder - A Retrospective Chart Review.

Individual alpha frequency (IAF) is a biomarker of neurophysiological functioning. The IAF-guided repetitive transcranial magnetic stimulation (α-rTMS) is increasingly explored in diverse neurological conditions. However, there is limited data on the efficacy and safety of α-rTMS in children with autism spectrum disorder (ASD). The IAF, childhood autism rating scale (CARS), Pediatric Quality of Life Inventory 4.0 (PedsQLTM 4.0), and semi-structured interview data of patients that received 19 α-rTMS sessions (4 weeks) were aggregated and analysed using paired student t-test and descriptive method. Data were retrieved from 28 patients (26 males, aged 3-9years (mean ± SD age: 6.1 ± 1.8years)). The post-α-rTMS data shows a significant improvement in IAF (9.4Hz; p ≤ 0.025) towards 10Hz. The CARS and PedsQLTM 4.0 surveys indicate that patients' ASD symptoms and quality of life improved significantly. Specifically, reports from semi-structured interviews suggest improved sleep trouble - the most significant comorbidity. The experiences of minor side effects such as hyperactivity resolved within two hours following α-rTMS sessions. This study presents evidence on the efficacy and safety of α-rTMS in improving ASD symptoms, quality of life and comorbid sleep troubles in children. However, these findings should be interpreted as preliminary pending the presentation of double-blind, randomised clinical trials.

Efficacy and safety of repetitive transcranial magnetic stimulation in children and adolescents with depression: A systematic review and preliminary meta-analysis

BackgroundRepetitive transcranial magnetic stimulation (rTMS) benefits adults with depression while its efficacy and safety in children and adolescents with major depressive disorder (MDD) remain unclear. We conducted a preliminary meta-analysis here to objectively appraise rTMS in the youth with MDD to inform future research and clinical practice. MethodsWe searched Pubmed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials from their inception to December 1, 2021. Studies with a control group or self-controlled designs and evaluating the Hamilton Depression Scale (HAM-D) or the Children's Depression Rating Scale–Revised (CDRS-R) at baseline and post-rTMS treatment were included. Two reviewers independently selected eligible studies, retrieved data in a structured fashion and assessed studies' quality. Hedges'g with 95 % confidence intervals and withdrawal rate with 95 % confidential intervals were separately used to evaluate the efficacy and safety of rTMS. ResultsThirteen studies with six datasets (165 patients, 61.8 % female, age range from 10 to 25 years old) were included and our meta-analysis found children and adolescents with MDD benefited from rTMS treatment (Hedges'g 1.37, 95 % CI 0.85 to 1.90, P = 0.001). In addition, 4 % of patients (95 % CI 0.02 to 0.09) withdrew during rTMS treatment for reasons including fear, mood swings, suicide ideation and adverse events. LimitationsThis conclusion is tempered by a small number of studies included and a potentially existing placebo effect. ConclusionsOur findings suggest rTMS could benefit children and adolescents with MDD in a relatively safe manner, and this result may help guide clinical practice.

TU-194. Safety of, adherence to, and satisfaction with repetitive neuromuscular magnetic stimulation in children and adolescents with episodic migraine

TU-194. Safety of, adherence to, and satisfaction with repetitive neuromuscular magnetic stimulation in children and adolescents with episodic migraine

The therapeutic role of repetitive transcranial magnetic stimulation in children with attention deficit/hyperactivity disorder in Egypt a randomized sham controlled clinical trial

BackgroundRepetitive transcranial magnetic stimulation showed some evidence for improving symptoms of ADHD along with its relative safety, thus could serve as a treatment strategy or an alternative to stimulant medication. Accordingly, 60 children with ADHD were assessed, and 30 participants were allocated to the rTMS group and received 15 sessions of rTMS over the right dorsolateral prefrontal cortex combined with Atomoxetine 1.2 mg/kg/day. The other 30 participants were allocated to the Sham group and received 15 sessions of sham rTMS and atomoxetine 1.2 mg/kg/day. Clinical assessments of ADHD symptoms and severity were done and compared at 3 points, before treatment, after receiving 15 sessions of rTMS and follow-up 1 month after the last rTMS session, using Conner’s Parent Rating Scale-Revised-Long form, Children’s Global Assessment Scale, and Clinical Global Impression.ResultsThe two groups show significant improvement in the T scores of all CPRS subscales, CGI and CGAS. However, the rTMS group had a significantly more improvement than the sham group in inattention, total ADHD severity, CGI, and CGAS after rTMS and continued to the follow-up after 1 month.ConclusionsrTMS is an efficacious intervention for treating ADHD, and combined rTMS and atomoxetine is superior to atomoxetine alone in improving attention deficit symptoms and total ADHD symptoms severity.Trial registrationPACTR, PACTR202110558451583. Registered 25 June 2021. Approved 29 October 2021- Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=15968.

Repetitive neuromuscular magnetic stimulation in children with headache.

Repetitive neuromuscular magnetic stimulation (rNMS) was previously applied in adult patients with episodic migraine, showing beneficial effects on headache characteristics, high safety, and convincing satisfaction. This study aims to assess rNMS as a personalized intervention in pediatric headache. Retrospective chart review including patients with migraine, TTH, mixed type headache, or PTH, who had received at least one test rNMS session targeting the upper trapezius muscles (UTM). 33 patients (13.9±2.5 years; 61% females) were included in the primary analysis, resulting in a total of 182 rNMS sessions. 43 adverse events were documented for 40 of those sessions (22%). Most common side effects were tingling (32.6%), muscle sore (25.5%), shoulder (9.3%) and back pain (9.3%). Secondly, in patients (n=20) undergoing the intervention, headache frequency (p=0.017) and minimum and maximum intensities (p=0.017; p=0.023) significantly decreased from baseline to 3-month after intervention. 11 patients (44%) were classified as ≥25% responders, with 7 patients (28%) experiencing a ≥75% reduction of headache days. After 73% of interventions, patients reported rNMS helped very well or well. A majority of patients would repeat (88.5%) and recommend rNMS (96.2%) to other patients. rNMS seems to meet the criteria of safety, feasibility, and acceptance among children and adolescents with three age-typical headache disorders. A significant reduction in headache frequency and intensity during a 3 months follow-up was documented. Larger, prospective, randomized, sham-controlled studies are urgently needed to confirm if rNMS may become a new valuable non-invasive, non-pharmacological treatment option for pediatric headache disorders.

P 45 Satisfaction with and safety of repetitive neuromuscular magnetic stimulation in children with headache disorders

Question To assess the safety of and satisfaction with a repetitive neuromuscular magnet stimulation (NMS) intervention targeting to the upper trapezius muscles (UTM) in pediatric patients with headache disorders. Methods Retrospective chart review including 33 patients with migraine, tension-type headache, or post-traumatic headache, who had received at least one test rNMS session targeting to UTM. In patients choosing to undergo rNMS intervention, adherence rate was calculated based on the number of completed rNMS sessions. For patients undergoing the rNMS intervention, safety of and satisfaction with the intervention were assessed by customized questionnaires. Results 33 patients (13.94 ± 2.51 years; 61% females) received at least a test rNMS session to become acquainted with the stimulation setting, resulting in 182 rNMS sessions. In 142 sessions (78%) no adverse events were reported. 43 adverse events were documented for 40 sessions (22%). Related side effects during stimulation included tingling (32.6%), shoulder pain (9.3%), back pain (9.3%), feeling of heaviness (4.7%), trembling (2.3%), and unpleasant tension (2.3%). Related side effects in-between interventions included muscle sore (25.5%), headache (4.7%), and a short-lasting muscle cramp in the upper arm (2.3%). Adverse events categorized unlikely related to the intervention were described in 3 sessions by 2 patients and included shoulder pain (4.7%) and an electrifying feeling radiating to the right hip (2.3%). In these 33 patients, 6 patients (18%) did not continue after the test rNMS session and 4 patients (12%) who started the intervention did not complete the full treatment. 23 patients (70%) completed 28 rNMS interventions with at least 5 of 6 sessions. At follow-up (FU) of 24 interventions, patients completed the customized satisfaction questionnaire. After 13 interventions (54.2%), the treatment was rated as “the therapy helped very well”, after 5 interventions (20.8%) as “the therapy helped well”, after 1 intervention (4.2%) as “indecisive”, after 3 interventions as “the therapy rather did not help”, and after 2 interventions as “the therapy did not help”. At FU of 25 interventions, patients completed the customized questionnaire regarding repetition of the treatment. After 23 interventions (88.5%), patients would repeat the treatment. At FU of 19 interventions, patients completed the questionnaire regarding recommendation of treatment. After 18 interventions (96.2%), patients would recommend rNMS to other affected patients. Conclusion Stimulation by rNMS was found to be a feasible, safe, and well-accepted treatment option for children and adolescents with headache disorders. Thus, rNMS of the UTM may become a valuable non-invasive, non-pharmacological treatment option for pediatric headache disorders.

Changes of Structural Brain Network Following Repetitive Transcranial Magnetic Stimulation in Children With Bilateral Spastic Cerebral Palsy: A Diffusion Tensor Imaging Study.

Introduction: Bilateral spastic cerebral palsy (BSCP) is the most common subtype of cerebral palsy (CP), which is characterized by various motor and cognitive impairments, as well as emotional instability. However, the neural basis of these problems and how repetitive transcranial magnetic stimulation (rTMS) can make potential impacts on the disrupted structural brain network in BSCP remain unclear. This study was aimed to explore the topological characteristics of the structural brain network in BSCP following the treatment of rTMS.Methods: Fourteen children with BSCP underwent 4 weeks of TMS and 15 matched healthy children (HC) were enrolled. Diffusion tensor imaging (DTI) data were acquired from children with bilateral spastic cerebral palsy before treatment (CP1), children with bilateral spastic cerebral palsy following treatment (CP2) and HC. The graph theory analysis was applied to construct the structural brain network. Then nodal clustering coefficient (Ci) and shortest path length (Li) were measured and compared among groups.Results: Brain regions with significant group differences in Ci were located in the left precental gyrus, middle frontal gyrus, calcarine fissure, cuneus, lingual gyrus, postcentral gyrus, inferior parietal gyri, angular gyrus, precuneus, paracentral lobule and the right inferior frontal gyrus (triangular part), insula, posterior cingulate gyrus, precuneus, paracentral lobule, pallidum. In addition, significant differences were detected in the Li of the left precental gyrus, lingual gyrus, superior occipital gyrus, middle occipital gyrus, superior parietal gyrus, precuneus and the right median cingulate gyrus, posterior cingulate gyrus, hippocampus, putamen, thalamus. Post hoc t-test revealed that the CP2 group exhibited increased Ci in the right inferior frontal gyrus, pallidum and decreased Li in the right putamen, thalamus when compared with the CP1 group.Conclusion: Significant differences of node-level metrics were found in various brain regions of BSCP, which indicated a disruption in structural brain connectivity in BSCP. The alterations of the structural brain network provided a basis for understanding of the pathophysiological mechanisms of motor and cognitive impairments in BSCP. Moreover, the right inferior frontal gyrus, putamen, thalamus could potentially be biomarkers for predicting the efficacy of TMS.

Cortical excitability measured with transcranial magnetic stimulation in children with epilepsy before and after antiepileptic drugs.

To evaluate cortical excitability with transcranial magnetic stimulation (TMS) in children with new-onset epilepsy before and after antiepileptic drugs (AEDs). Fifty-five drug-naïve patients (29 females, 26 males; 3-18y), with new-onset epilepsy were recruited from 1st May 2014 to 31st October 2017 at the Child Neurology Department, Queen Silvia's Children's Hospital, Gothenburg, Sweden. We performed TMS in 48 children (23 females, 25 males; mean [SD] age 10y [3y], range 4-15y) with epilepsy (27 generalized and 21 focal) before and after the introduction of AEDs. We used single- and paired-pulse TMS. We used single-pulse TMS to record resting motor thresholds (RMTs), stimulus-response curves, and cortical silent periods (CSPs). We used paired-pulse TMS to record intracortical inhibition and facilitation at short, long, and intermediate intervals. There were no differences in cortical excitability between children with generalized and focal epilepsy at baseline. After AED treatment, RMTs increased (p=0.001), especially in children receiving sodium valproate (p=0.005). CSPs decreased after sodium valproate was administered (p=0.050). As in previous studies, we noted a negative correlation between RMT and age in our study cohort. Paired-pulse TMS could not be performed in most children because high RMTs made suprathreshold stimulation impossible. Cortical excitability as measured with RMT decreased after the introduction of AEDs. This was seen in children with both generalized and focal epilepsy who were treated with sodium valproate, although it was most prominent in children with generalized epilepsy. We suggest that TMS might be used as a prognostic tool to predict AED efficacy. Resting motor threshold (RMT) correlated negatively with age in children with epilepsy. No differences in cortical excitability were noted between patients with generalized and focal epilepsy. Treatment with antiepileptic drugs decreased cortical excitability as measured with transcranial magnetic stimulation (TMS). Decreased cortical excitability with increased RMT was recorded, especially after sodium valproate treatment. Paired-pulse TMS was difficult to perform because of high RMTs in children.

Mapping contralesional motor cortex plasticity using robotic transcranial magnetic stimulation in children with perinatal stroke

Introduction: Children with perinatal stroke are disabled by hemiparetic cerebral palsy (HCP). Motor control of the affected limb often resides in the contralesional hemisphere with preserved ipsilateral connections. Intensive therapies improve hand function but predictors are unknown. Individualized maps of the motor cortex (M1) may provide insight but are poorly studied. We aimed to use robotic TMS to characterize contralesional motor maps and their association with hand function in HCP.

Clinical effectiveness of repetitive transcranial magnetic stimulation treatment in children and adolescents with neurodevelopmental disorders: A systematic review.

Neurodevelopmental disorders, including autism spectrum disorder, are common in children and adolescents, but treatment strategies remain limited. Although repetitive transcranial magnetic stimulation has been studied for neurodevelopmental disorders, there is no clear consensus on its therapeutic effects. This systematic review examined literature on repetitive transcranial magnetic stimulation for children and adolescents with neurodevelopmental disorders published up to 2018 using the PubMed database. The search identified 264 articles and 14 articles met eligibility criteria. Twelve of these studies used conventional repetitive transcranial magnetic stimulation and two studies used theta burst stimulation. No severe adverse effects were reported in these studies. In patients with autism spectrum disorder, low-frequency repetitive transcranial magnetic stimulation and intermittent theta burst stimulation applied to the dorsolateral prefrontal cortex may have therapeutic effects on social functioning and repetitive behaviors. In patients with attention deficit/hyperactivity disorder, low-frequency repetitive transcranial magnetic stimulation applied to the left dorsolateral prefrontal cortex and high-frequency repetitive transcranial magnetic stimulation applied to the right dorsolateral prefrontal cortex may target inattention, hyperactivity, and impulsivity. In patients with tic disorders, low-frequency repetitive transcranial magnetic stimulation applied to the bilateral supplementary motor area improved tic symptom severity. This systematic review suggests that repetitive transcranial magnetic stimulation may be a promising intervention for children and adolescents with neurodevelopmental disorders. The results warrant further large randomized controlled trials of repetitive transcranial magnetic stimulation in children with neurodevelopmental disorders.

T126. Mapping contralesional motor cortex using robotic transcranial magnetic stimulation in children with perinatal stroke

Introduction Children with perinatal stroke have motor deficits lateralized to one side of the body (hemiparetic cerebral palsy, HCP). Motor control of the affected limb often resides in the contralesional hemisphere with preservation of ipsilateral corticospinal connections. Intensive therapies can improve hand function but mechanisms and predictors of response are unknown. Individualized maps of the motor cortex may provide insight but only two studies have examined this where manual motor mapping was tedious and potentially insensitive. This study aimed to determine the feasibility of using robotic transcranial magnetic stimulation (TMS) motor mapping to better characterize integrated motor maps of the contralesional hemisphere and their association with clinical function. Methods Ten children with unilateral perinatal stroke and HCP (aged 8–19 years) participated in a randomized controlled, double-blinded clinical trial. Children were engaged in a 2-week, goal-directed, child-friendly intensive intervention (constraint and bimanual therapies). Children were randomized to receive 20 min/day of contralesional motor cortex (M1) transcranial direct current stimulation (tDCS) or sham (1:1). Robotic TMS (Axilum Robotics) applied 4 single-pulses to each target on a custom map (12 × 12, 7 mm spacing) over the motor cortex at baseline and within one-week after intervention. Surface electromyography was recorded in bilateral first dorsal interosseous (FDI). Primary neurophysiological measures included the percentage overlap (sites inducing a motor evoked potential (MEP) in both FDI/sites inducing an MEP in the affected FDI), and area of bilateral FDI maps. Clinical outcome was assessed with the Jebsen-Taylor Test of Hand Function (JTTHF). Paired t-tests were performed to examine therapy-associated changes in all measures. Results All children completed the intervention. Two children with incomplete clinical assessments were excluded. Contralesional motor maps were successfully probed by using TMS robot. Motor map parameters did not correlate with clinical scores at baseline (p > 0.1). Percentage overlap of bilateral FDI in the contralesional M1 did not change (n = 7, baseline = 74.5 ± 29.5%, post = 71.7 ± 27.1%, p = 0.86). Averaged motor map areas of unaffected FDI may have increased from 1245 ± 854 mm2 at baseline to 1583 ± 981 mm2 after intervention (n = 10, p = 0.21). Motor map areas of the affected FDI did not change after intervention (n = 7, baseline = 1365 ± 951 mm2, post = 1358 ± 844 mm2,p = 0.98). On average, children moved 23.5 ± 20.8 s faster (12.6 ± 9.6%) with the more-affected hand in JTTHF after intervention (p = 0.02). Change in performance was not associated with change in motor map parameters. Conclusion Our preliminary findings demonstrated that it is feasible to study motor map characteristics using a TMS robot in children with HCP. The utility of using such motor maps as biomarkers to understand and predict treatment outcome will become clearer with completion of larger samples within this and other trials.

P 123 Prefrontal transcranial magnetic stimulation in children with attention deficit/hyperactivity disorder (ADHD)

Background Attention deficit/ hyperactivity disorder (ADHD) is characterized by a preference of immediate over delayed rewards. 1 Hz inhibitory repetitive transcranial magentic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) has been shown to influence decisions of reward preference in adult subjects towards smaller immediate rewards. Methods Here we examine the effects of high frequency (excitatory) DLPFC rTMS in a small sample of adult subjects with ADHD. A delay discounting task was applied before and after rTMS. Results After rTMS the preference of subjects with ADHD was changed in a marginally significant way towards larger but more delayed rewards compared to sham stimulation. Discussion/Significance These are pilot data which encourage further research on whether rTMS is not only able to discrupt the cortical circuits involved in attentional top-down control and the ability to wait longer times for larger rewards, but whether rTMS is able to both decrease as well as increase cortical excitability leading to different behavioral effects. Such behavioral effects could represent a clinically valuable therapeutic tool. However, a replication of our finding is needed in a larger independent sample.

Hearing Safety From Single- and Double-Pulse Transcranial Magnetic Stimulation in Children and Young Adults.

Concerns regarding hearing safety have limited the number of studies using transcranial magnetic stimulation (TMS) in children and young adults. The objective of this study was to examine the safety of TMS with regards to hearing in a group of 16 children and young adults (17.3 ± 4.9 years) with and without brain injury. Pure-tone hearing thresholds and distortion-product otoacoustic emissions were measured before and after exposure to single- and paired-pulse TMS (1-2 sessions of 149-446 TMS pulses at a median of 49%-100% maximum stimulator output over a 2.2 hours period). No mean change in hearing outcomes was noted. In addition, no clinically significant change in hearing threshold was observed in any participant, and participants did not experience a subjective change in hearing after TMS exposure. Single- and double-pulse TMS administered within the parameters used in this study, which included hearing protection, can be used in children and young adults without impacting hearing. This study provides further evidence for hearing safety after TMS exposure in children and young adults.

Diagnostic transcranial magnetic stimulation in children with acute inflammatory demyelinating polyneuropathy

Diagnostic transcranial magnetic stimulation in children with acute inflammatory demyelinating polyneuropathy

P005 Transcranial magnetic stimulation in the evaluation of the functional state of central nervous system neurons under the robotic neurorehabilitation

Objective Our goal was to evaluate functional state of central nervous system with transcranial magnetic stimulation in children under robotic rehabilitation therapy. Design 54 children (age 12–16) with neurologic deficits (23 with viral encephalitis sequelae and 31 with cerebral palsy), were enrolled. Patients were equally distributed to robotic rehabilitation group and controls. Interventions: 31 patient underwent 10 rehabilitation sessions on robotic rehabilitation device “MotionMaker”; 23 controls underwent excercise therapy and massage. All were twice evaluated by TMS (single pulse protocol): 1 day before and 1 day after the therapy. Neuro-MS-D stimulator and Neuro-MVP system were implemented, 90-sm round coil was used. Latency, threshold, duration and shape of motor evoked potential (MEP) and central motor conduction time (CMCT) were evaluated. Results In both groups threshold of MEP dropped at the second evaluation: in robotic therapy group average drop was on 42% (p0.05). Duration of MEPs in both groups expanded on 12%. CMCT, latency and amplitudes changes were insignificant in both groups. Conclusions Both treatment regimes raised functional activity of motor cortex; in robotic therapy group this effect was significant. There were trend towards more pronounced conductivity improvement in robotic therapy group. Robotic neurorehabilitation therapy proved to be more effective in treatment of children with neurologic disorders after viral encephalitis and cerebral palsy. Thus, neurorehabilitation in children may raise the functional state of central nervous system neurons, which may be measured by single-pulse protocol TMS.

Repetitive -transcranial magnetic stimulation in children with attention deficit hyperactivity disorder: effects on behavior and P300 event-related potential

Evidence from clinical populations, such as epilepsy and attention deficit/hyperactivity disorder, suggests a relationship between hyperexcitability and cognitive impairment, but this relationship has not been demonstrated in healthy individuals. Here, we investigate the relationship between cortical excitability and cognitive functioning in healthy adults. Single- and paired-pulse TMS was applied to 20 healthy adults to measure cortical excitability and long-interval intracortical inhibition (LICI). A neuropsychological battery was administered to assess aspects of attention, executive function, and mood. Participants with primarily excitatory responses to the LICI paradigm performed worse on a composite measure of attention and reported more negative mood states than participants with primarily inhibitory responses.Thus, differences in attention and mood among healthy adults are related to differences in cortical excitability as measured by LICI. This is consistent with a role for GABAB inhibitory circuits in regulating attention and mood, and suggests that individual variability in these domains may reflect variability in cortical excitability. This study demonstrates preliminary evidence that increased cortical excitability is associated with poorer cognition and mood in healthy adults. These findings provide new insight into the presence of cognitive dysfunction in several patient populations with hyperexcitability and support the development of neurostimulation interventions for clinical use.

Clinical Applications of Transcranial Magnetic Stimulation in Pediatric Neurology

Noninvasive brain stimulation is now an accepted technique that is used as a diagnostic aid and in the treatment of neuropsychiatric disorders in adults, and is being increasingly used in children. In this review, we will discuss the basic principles and safety of one noninvasive brain stimulation method, transcranial magnetic stimulation. Improvements in the spatial accuracy of transcranial magnetic stimulation are described in the context of image-guided transcranial magnetic stimulation. The article describes and provides examples of the current clinical applications of transcranial magnetic stimulation in children as an aid in the diagnosis and treatment of neuropsychiatric disorders and discusses future potential applications. Transcranial magnetic stimulation is a noninvasive tool that is safe for use in children and adolescents for functional mapping and treatment, and for many children it aids in the preoperative evaluation and the risk-benefit decision making.