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Intervention-Induced Motor Cortex Plasticity in Hemiparetic Children With Perinatal Stroke
Hsing-Ching Kuo1,2,3, Ephrem Zewdie1,2,3, Patrick Ciechanski1,2
11 Alberta Children's Hospital, Calgary, Alberta, Canada.
Neurorehabilitation and Neural Repair
|October 5, 2018
Summary
Intensive therapy with brain stimulation improved hand function in children with perinatal stroke. Neurophysiological changes in the motor cortex may serve as biomarkers for personalized neurorehabilitation.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Pediatric Neurology
Background:
- Perinatal stroke causes hemiparesis in children, impacting hand function.
- Intensive therapy and brain stimulation show promise for improving function, but mechanisms and individual variability are unclear.
- Investigating primary motor cortex (M1) neurophysiology can reveal biomarkers for personalized neurorehabilitation.
Purpose of the Study:
- To explore M1 neurophysiology and plasticity in children with hemiparesis undergoing intensive therapy and brain stimulation.
- To identify potential neurophysiological biomarkers for treatment response in pediatric neurorehabilitation.
Main Methods:
- A blinded, sham-controlled trial involved 45 children with hemiparesis receiving intensive upper extremity therapy.
- Participants were randomized to receive repetitive transcranial magnetic stimulation (rTMS), constraint therapy, both, or neither.
- Transcranial magnetic stimulation (TMS) assessed motor-evoked potential (MEP) amplitudes, stimulus recruitment curves (SRC), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Clinical outcomes included the Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM).
Main Results:
- Both function (AHA) and goal performance (COPM) improved, with additive benefits from rTMS and constraint therapy (P < .01).
- Post-intervention, MEP amplitudes and SRC from the contralesional M1 to the less-affected hand increased (P < .02 and P < .01, respectively).
- SICI of the contralesional M1 to the less-affected hand decreased (P < .04), while ICF showed no significant changes (P > .12).
Conclusions:
- TMS can effectively probe M1 neurophysiology and plasticity in children with cerebral palsy undergoing neuromodulation.
- Increased MEP amplitudes and decreased SICI may indicate mechanisms of interventional plasticity.
- These neurophysiological changes show potential as biomarkers for personalized medicine in pediatric neurorehabilitation.
Keywords:
cerebral palsyconstraint induced movement therapyhemiplegianeurophysiologyperinatal stroketranscranial magnetic stimulationMore Related Videos
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