Non-invasive brain stimulation for upper extremity dysfunction in children with cerebral palsy: a systematic review
Yage Zhang1, Mengru Zhong1, Tingting Peng1
1Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Background:
Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are the most commonly used non-invasive brain stimulation (NIBS) techniques. However, NIBS for upper extremity dysfunction remains unclear in children with cerebral palsy (CP). Thus, we aim to determine safety and effectiveness of NIBS for upper extremity dysfunction in children with CP.
Methods:
Two reviewers conducted literature search on five databases including PubMed, Web of Science, ProQuest, Scopus, and Embase independently. Systematic review and meta-analyses of included studies were conducted. Studies used standardized mean difference (SMD) and 95% confidence interval (CI) to calculate pooled effect size between two groups. The statistics I2 was used to assess the heterogeneity between randomized controlled trials (RCTs).
Results:
Fifteen studies were included, with seven of which examined rTMS and eight studied tDCS. Total 366 children with CP were included. Changes in Box and Block Test (BBT) of the affected hand changed significantly in post (SMD =0.68; 95% CI: 0.02 to 1.34; P=0.044; I2=0%) and 90-minute effect (SMD =0.69; 95% CI: 0.02 to 1.36; P=0.04; I2=0%), and Modified Ashworth Scale (MAS) (SMD =-0.51; 95% CI: -0.99 to -0.03; P=0.04; I2=0%) after using tDCS were statistically significant. There was no difference of total number of dropouts between each group. No patients experienced serious adverse events.
Conclusions:
NIBS is safe and well tolerated in children with CP. And current evidence suggests that when safety guidelines are followed, NIBS does not induce seizures in pediatric patients with no history of epilepsy or stable epilepsy. tDCS is effective in improving upper extremity dysfunction such as fine motor function especially hand dexterity, and reducing upper extremity spasticity in children with CP. Due to insufficient studies, the effectiveness of rTMS is uncertain.
