Long Term Effects of 5-Hz rTMS over M1 Cortex in Spastic Cerebral Palsy: A Pilot Randomized Controlled Trial
Keywords:cerebral palsy, spasticity, repetitive transcranial magnetic stimulation
Objectives: To determine long term effect of repetitive transcranial magnetic stimulation (rTMS) on muscle tone reduction and mobility in children with spastic cerebral palsy (CP).
Study design: A pilot randomized controlled trial.
Setting: Southern Rehabilitation Center, Songklanagarind Hospital.
Subjects: Spastic CP aged 5-18 years old with modified Ashworth Scale (MAS) of extremities graded 1 to 3.
Methods: Participants were randomized into 2 groups, rTMS and sham groups. The rTMS group received 1500 stimuli of 5-Hz stimulation, 90% resting motor threshold stimulation over the primary motor cortex for 10 consecutive working days. The sham group received 10% resting motor threshold intensity over the same area and duration of stimulation. Both groups received a standard rehabilitation program during experimental periods. Outcome measurements included MAS of extremity muscles and joint range of motion (ROM) at angle of catch (Tardieu’s R1) for muscle tone and the Gross Motor Function Classification System - expanded and revised (GMFCS-ER) Thai version for mobility, were assessed before intervention, immediately after intervention, and follow up at 1, 2, 4 and 8 weeks after the last treatment session.
Results: Eighteen children were recruited, mean age (SD) was 95.9 (31.7) months in the rTMS group and 93.8 (20.4) months in the sham group. Their GMFCS-ER was classified as level 3 to 5. After completion of 10 sessions, there were no significant changes in MAS. ROMs at angle of catch tended to increase post intervention and during follow up period in the rTMS group. Mobility levels according to GMFCS-ER were constant within group and no difference between groups. No serious adverse event was reported entire this study.
Conclusion: 5-Hz rTMS over the primary motor cortex for 10 days had no additive effects of spasticity or muscle tone reduction or functional improvement in children with spastic cerebral palsy.
Keywords: cerebral palsy, spasticity, repetitive transcranial magnetic stimulation
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