Neuromodulation for Children With Hemiparesis and Perinatal Stroke: A Randomized Clinical Trial

Area of Science:

• Neuroscience
• Pediatric Rehabilitation
• Motor Control

Background:

• Children with unilateral cerebral palsy often experience inconsistent outcomes with current upper-extremity therapies.
• Noninvasive brain stimulation techniques, such as transcranial direct current stimulation (tDCS), show potential for enhancing motor gains when combined with traditional therapy.

Purpose of the Study:

• To investigate if adding neurostimulation to upper-extremity therapy improves motor function in children with perinatal stroke and unilateral cerebral palsy.

Main Methods:

• A multicenter, randomized, sham-controlled phase 3 trial involved 107 children (6-18 years) with unilateral cerebral palsy.
• Participants received either daily sham or cathodal tDCS to the contralesional motor cortex during 10 days of intensive upper-extremity therapy.
• Outcomes included hand function and goal attainment, assessed 6 months post-therapy; intention-to-treat analysis was used.

Main Results:

• Eighty-nine children were enrolled and randomized. Significant functional gains were observed in both groups, sustained at 6 months.
• No significant differences were found between the tDCS and sham groups in hand function or goal attainment.
• The procedures were safe and well-tolerated, with no serious adverse events reported.

Conclusions:

• Patient-centered intensive motor learning programs can lead to significant and sustained improvements in upper-extremity function for children with unilateral cerebral palsy.
• The addition of 1 mA contralesional motor cortex tDCS did not provide additional benefits over sham stimulation in this population.