Department of Occupational Therapy, Marquette University, 1700 West Wells St., Room 140, Milwaukee, WI, 53201, USA.
Department of Neurology, Medical University of South Carolina, 208B Rutledge Avenue, Charleston, SC, 29425, USA.
Eur J Paediatr Neurol. 2023 Mar;43:27-35. doi: 10.1016/j.ejpn.2023.01.013. Epub 2023 Feb 28.
Children with hemiparesis (CWH) due to stroke early in life face lifelong impairments in motor function. Transcranial direct current stimulation (tDCS) may be a safe and feasible adjuvant therapy to augment rehabilitation. Given the variability in outcomes following tDCS, tailored protocols of tDCS are required. We evaluated the safety, feasibility, and preliminary effects of a single session of targeted anodal tDCS based on individual corticospinal tract organization on corticospinal excitability. Fourteen CWH (age = 13.8 ± 3.63) were stratified into two corticospinal organization subgroups based on transcranial magnetic stimulation (TMS)-confirmed motor evoked potentials (MEP): ipsilesional MEP presence (MEP+) or absence (MEP-). Subgroups were randomized to real anodal or sham tDCS (1.5 mA, 20 min) applied to the ipsilesional (MEP + group) or contralesional (MEP- group) hemisphere combined with hand training. Safety was assessed with questionnaires and motor function evaluation, and corticospinal excitability was assessed at baseline and every 15 min for 1 h after tDCS. No serious adverse events occurred and anticipated minor side effects were reported and were self-limiting. Six of 14 participants had consistent ipsilesional MEPs (MEP + group). Paretic hand MEP amplitude increased in 5/8 participants who received real anodal tDCS to either the ipsilesional or contralesional hemisphere (+80% change). Application of tDCS based on individual corticospinal organization was safe and feasible with expected effects on excitability, indicating the potential for tailored tDCS protocols for CWH. Additional research involving expanded experimental designs is needed to confirm these effects and to determine if this approach can be translated into a clinically relevant intervention.
患有早期脑卒中导致的偏瘫的儿童（CWH）面临终生的运动功能障碍。经颅直流电刺激（tDCS）可能是一种安全且可行的辅助治疗方法，可增强康复效果。鉴于 tDCS 后的结果存在差异，需要制定针对 tDCS 的个体化方案。我们评估了基于个体皮质脊髓束组织的单次靶向阳极 tDCS 对皮质脊髓兴奋性的安全性、可行性和初步效果。根据经颅磁刺激（TMS）确认的运动诱发电位（MEP），将 14 名 CWH（年龄为 13.8 ± 3.63 岁）分为两个皮质脊髓组织亚组：同侧 MEP 存在（MEP+）或不存在（MEP-）。将亚组随机分为真阳极 tDCS（1.5 mA，20 分钟）或假 tDCS 组，分别应用于同侧（MEP+组）或对侧（MEP-组）半球，并结合手部训练。通过问卷调查和运动功能评估评估安全性，并在 tDCS 前后每隔 15 分钟评估皮质脊髓兴奋性 1 小时。未发生严重不良事件，仅报告了预期的轻微副作用，且为自限性。14 名参与者中有 6 名同侧 MEP 持续存在（MEP+组）。5/8 名接受真阳极 tDCS 治疗同侧或对侧半球的参与者的患手 MEP 幅度增加（增加 80%）。基于个体皮质脊髓组织的 tDCS 应用是安全且可行的，对兴奋性有预期影响，表明 CWH 的个体化 tDCS 方案具有潜力。需要开展涉及扩展实验设计的进一步研究，以确认这些效果，并确定这种方法是否可以转化为具有临床相关性的干预措施。
