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Published on: August 23, 2022
Longitudinal study of single-pulse TMS in infants with perinatal brain injury: safety and feasibility
Kellie M Collins1,2, Cameron P Casey2, Ellen N Sutter1,2,3
1Division of Developmental Pediatrics & Rehabilitation Medicine, Department of Pediatrics, Waisman Center, University of Wisconsin-Madison, Madison, WI, United States.
Insights
Repeated single-pulse transcranial magnetic stimulation (spTMS) is safe and feasible for infants with perinatal brain injury. This method allows for longitudinal studies of neuroplasticity and motor pathway development in this vulnerable population.
Area of Science:
- Neuroscience
- Pediatrics
- Biomedical Engineering
Background:
- Perinatal brain injury is a primary cause of cerebral palsy.
- Investigating motor pathway development in infants is crucial for early intervention.
- Limited data exist on the safety and feasibility of repeated single-pulse transcranial magnetic stimulation (spTMS) in infants.
Purpose of the Study:
- To conduct the first longitudinal evaluation of the safety, tolerability, and feasibility of spTMS in infants with perinatal brain injury.
- To establish a reproducible framework for spTMS in a vulnerable infant population.
Main Methods:
- Twenty infants (corrected age 3-25 months) with perinatal brain injury underwent 46 spTMS sessions.
- Safety and tolerability were assessed via heart rate, respiratory rate, and the Modified Behavioral Pain Scale (MBPS).
- Feasibility was measured by session completion, participant retention, and motor-evoked potential (MEP) acquisition.
Main Results:
- No adverse events were recorded across 2,527 pulses.
- Physiological measures and MBPS scores remained stable.
- Analyzable electromyography (EMG) was obtained in 100% of sessions, with MEPs elicited in 95.7% of sessions.
- A high retention rate (85%) indicated excellent protocol acceptability.
Conclusions:
- Repeated spTMS is a safe, tolerable, and feasible method for infants with perinatal brain injury.
- This study provides a methodological advance for future research on neuroplasticity and corticospinal tract development.
- Findings may help identify biomarkers to guide early interventions for infants with early brain injury.
Introduction:
Perinatal brain injury is a leading cause of cerebral palsy. Single-pulse transcranial magnetic stimulation (spTMS) provides a non-invasive method for investigating motor pathway development; however, data on the safety and feasibility of its repeated use in infants are limited. This study provides the first longitudinal evaluation of the safety, tolerability, and feasibility of spTMS in infants with perinatal brain injury.
Methods:
Twenty infants with perinatal brain injury (corrected age 3-25 months) participated in 46 spTMS sessions while awake. Safety and tolerability were systematically assessed using heart rate, respiratory rate, and the Modified Behavioral Pain Scale (MBPS). Feasibility was quantified by session completion, participant retention, and acquisition of motor-evoked potentials (MEPs) from bilateral wrist flexors.
Results:
Across 2,527 pulses, no adverse events occurred. Physiological measures and MBPS scores remained stable from pre- to post-stimulation. Analyzable electromyography (EMG) was obtained in 100% of sessions, with MEPs successfully elicited in 44/46 sessions (95.7%) across 19/20 infants (95%). A high longitudinal retention rate (85%) further demonstrated excellent protocol acceptability.
Discussion:
These findings establish a safe, reproducible framework for longitudinal spTMS in a vulnerable infant population. This methodological advance enables future investigations into neuroplasticity and corticospinal tract development after early brain injury, with the potential to yield biomarkers that guide the timing and targets of early interventions.
