Rich Tonya L, Menk Jeremiah S, Rudser Kyle D, Chen Mo, Meekins Gregg D, Peña Edgar, Feyma Timothy, Bawroski Kay, Bush Christina, Gillick Bernadette T
1 Department of Physical Medicine and Rehabilitation, Program in Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA.
2 Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA.
Clin EEG Neurosci. 2017 Nov;48(6):367-375. doi: 10.1177/1550059417709177. Epub 2017 May 22.
Transcranial direct current stimulation (tDCS) is increasingly researched as an adjuvant to motor rehabilitation for children with hemiparesis. The optimal method for the primary motor cortex (M1) somatotopic localization for tDCS electrode placement has not been established. The objective, therefore, was to determine the location of the M1 derived using the 10/20 electroencephalography (EEG) system and transcranial magnetic stimulation (TMS) in children with hemiparesis (CWH) and a comparison group of typically developing children (TDC). We hypothesized a difference in location for CWH but not for TDC. The 2 locations were evaluated in 47 children (21 CWH, 26 TDC). Distances between the locations were measured pending presence of a motor evoked potential. Distances between the EEG and TMS locations that exceeded the 2.5 cm × 2.5 cm rubber electrode area are reported in percentages [95% confidence interval] in CWH-nonlesioned hemisphere was 68.8% [41.3-89.0], lesioned: 85.7% [57.2-98.2]; TDC-dominant hemisphere 73.9% [51.6-89.8], nondominant: 82.6% [61.2-95.0]. Distances that exceeded the 3 × 5 cm electrode sponge area in CWH-nonlesioned was 25.0% [7.3-52.4], lesioned was 28.6% [8.4-58.1]; TDC-dominant was 52.2% [30.6-73.2], nondominant was 43.5 [23.2-65.5]). Distances that exceeded the 5 × 7 cm electrode sponge area in CWH-nonlesioned was 18.8% [4.0-45.6] and lesioned was 21.4% [4.7-50.8]; TDC-dominant was 21.7% [7.5-43.7] and nondominant was 26.1% [10.2-48.4]. Individual variability in brain somatotopic organization may influence surface scalp localization of underlying M1 in children regardless of neurologic impairment. Findings suggest further investigation of optimal tDCS electrode placement. EEG and TMS methods reveal variability in localizing M1 in children regardless of stroke diagnosis. This study was registered on clinicaltrials.gov NCT02015338.
经颅直流电刺激（tDCS）作为偏瘫儿童运动康复辅助手段的研究日益增多。tDCS电极放置的初级运动皮层（M1）躯体定位的最佳方法尚未确定。因此，本研究的目的是确定使用10/20脑电图（EEG）系统和经颅磁刺激（TMS）在偏瘫儿童（CWH）和发育正常儿童对照组（TDC）中得出的M1位置。我们假设CWH的位置存在差异，而TDC则无差异。对47名儿童（21名CWH，26名TDC）的两个位置进行了评估。测量两个位置之间的距离，同时观察是否存在运动诱发电位。超过2.5 cm×2.5 cm橡胶电极区域的EEG和TMS位置之间的距离以百分比[95%置信区间]报告，CWH非病变半球为68.8%[41.3 - 89.0]，病变半球为85.7%[57.2 - 98.2]；TDC优势半球为73.9%[51.6 - 89.8]，非优势半球为82.6%[61.2 - 95.0]。超过3×5 cm电极海绵区域的CWH非病变半球距离为25.0%[7.3 - 52.4]，病变半球为28.6%[8.4 - 58.1]；TDC优势半球为52.2%[30.6 - 73.2]，非优势半球为43.5[23.2 - 65.5]。超过5×7 cm电极海绵区域的CWH非病变半球距离为18.8%[4.0 - 45.6]，病变半球为21.4%[4.7 - 50.8]；TDC优势半球为21.7%[7.5 - 43.7]，非优势半球为26.1%[10.2 - 48.4]。无论神经功能是否受损，儿童大脑躯体定位组织的个体差异可能会影响其下M1在头皮表面的定位。研究结果表明需要进一步研究tDCS电极的最佳放置位置。EEG和TMS方法显示，无论是否患有中风，儿童M1定位均存在变异性。本研究已在clinicaltrials.gov上注册，注册号为NCT02015338。
