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Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy
Published on: August 9, 2024
Expert consensus-based clinical roadmap for non-invasive brain stimulation in children and adolescents with cerebral
Juliana Barbosa Goulardins1, Juliana Bilhar Marques2, Bibiana da Silveira Santos Machado3
1Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil; Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN Network), Brazil.
Aim:
To develop an expert consensus-based clinical roadmap, informed by a structured review of current evidence, to support clinical reasoning regarding the application of non-invasive brain stimulation (NIBS) in children and adolescents with cerebral palsy (CP).
Method:
A structured review of the literature was conducted to identify evidence regarding the use of NIBS in paediatric CP, prioritising meta-analyses, systematic reviews, and randomized controlled trials. Evidence related to stimulation targets, protocol characteristics, motor outcomes, and safety considerations was synthesised to inform the development of a preliminary clinical roadmap. The roadmap subsequently underwent refinement through a modified Delphi process involving clinicians and researchers with expertise in paediatric neurorehabilitation and neuromodulation. The Delphi process focused on evaluating the clinical applicability, feasibility, and usability of the proposed framework.
Results:
The final roadmap integrates current evidence with multidisciplinary expert consensus to support individualized clinical decision-making across motor domains and CP clinical presentations. Current evidence most consistently supports the consideration of NIBS as an adjunct to active rehabilitation for locomotor function in spastic diplegia and upper-limb function in spastic hemiplegia. Evidence for quadriplegia, ataxia, and dystonia remains limited and should be interpreted cautiously. The roadmap also incorporates expert consensus regarding safety considerations, clinical implementation, and outcome monitoring.
Interpretation:
This expert consensus-based roadmap provides a structured framework to support individualized and goal-oriented clinical decision-making regarding NIBS in paediatric CP. It is intended to facilitate the translation of heterogeneous evidence into clinical practice and should not be interpreted as a clinical guideline or formal recommendation document.
