Related Experiment Video
Updated: Jan 18, 2026
Randomized, Triple-Blind, and Parallel-Controlled Trial of Transcranial Direct Current Stimulation for Cognitive Rehabilitation after Stroke
Published on: June 6, 2025
Optimization Simulations of Transcranial Direct Current Stimulation Montages in Children With Perinatal Stroke
Martin Bardhi1, Ephrem Takele Zewdie2, Adam Kirton3
1Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
Insights
Individualized electrode placement optimizes transcranial direct current stimulation (tDCS) for children with perinatal stroke (PS). This approach enhances electric field strength and direction for improved motor function therapy.
Area of Science:
- Neuroscience
- Biomedical Engineering
- Pediatric Neurology
Background:
- Perinatal stroke (PS) is a leading cause of hemiparetic cerebral palsy.
- Transcranial direct current stimulation (tDCS) shows promise for improving motor function in children with PS.
- Optimal tDCS electrode placement for this population is unknown due to anatomical variations.
Purpose of the Study:
- To investigate if children with PS exhibit greater electrode displacement from standard tDCS montages.
- To determine if individualized electrode placement optimization can enhance electric field (EF) strength and direction at motor cortex targets.
- To explore the impact of optimized electrode placement on EF propagation patterns in children with PS.
Main Methods:
- Magnetic resonance imaging (MRI) data from children with PS and controls were used to create 3D mesh models.
- SimNIBS software modeled EF propagation for various tDCS electrode placements.
- Optimal placements were determined by maximizing EF strength or direction at the primary motor cortex (M1); electrode displacement and EF metrics were compared.
Main Results:
- Children with arterial ischemic stroke showed greater optimal electrode displacement posteriorly when optimizing for EF strength in the lesioned M1.
- Electrode displacement variability was higher in children with PS across all optimization strategies.
- Optimized montages improved EF metrics, with non-directional optimization increasing EF strength and directional optimization improving current angle at M1.
Conclusions:
- Individualized electrode placement can optimize tDCS current flow in children with PS, balancing EF strength and direction.
- tDCS current optimization holds potential for enhancing noninvasive neuromodulation therapies for pediatric disabilities.
- Further research into personalized tDCS protocols is warranted for this vulnerable population.
Background:
Perinatal stroke (PS) is a vascular brain injury that causes most hemiparetic cerebral palsy. Transcranial direct current stimulation (tDCS) applies a weak electric field (EF) to the scalp, and targeting motor cortex (M1) paired with therapy may improve motor function. However, owing to developmental differences and idiosyncratic anatomy after early injury, optimal electrode placements are not known. We optimized electrode placements on the basis of individual anatomy and explored the resulting EF propagation patterns.
Objective/Hypothesis:
We hypothesized that children with PS would have greater electrode displacement distances from standard montages and that optimizations could improve the strength and direction of EF at M1 targets.
Materials And Methods:
Magnetic resonance images of participants with PS and of controls were preprocessed, segmented, and converted to three-dimensional meshes. SimNIBS (Thielscher, Copenhagen, Denmark) modeled EF for various tDCS electrode placements. Optimal placements were modeled to maximize EF strength or direction at the targeted M1. Electrode displacement distances and directions in addition to EF metrics were compared in groups and optimization strategies.
Results:
Optimal electrode displacement distance was greater in the arterial ischemic stroke group when EF strength in the lesioned M1 was optimized (W = 4.31, p < 0.01), located further posterior than controls. The opposite trend was observed when current direction was optimized (W = 3.68, p = 0.025). Displacement direction had higher variability in children with PS across all optimizations. Montage optimization improved EF metrics. Specifically, the anodal nondirectionally optimized protocol caused greater EF strength in simulations of participants with PS. Directionally optimized montages altered average current angle through the target M1, making it closer to perpendicular to the posterior bank of the precentral gyrus in all groups.
Conclusions:
Individualized electrode placements may optimize tDCS current propagation in children with PS, with tradeoffs between current direction and EF strength. tDCS current optimization may improve noninvasive neuromodulation therapies in children with disabilities.
