Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA.
Burke Neurological Institute, White Plains, New York, and Weill Cornell Medicine, New York, New York, USA.
Dev Med Child Neurol. 2024 May;66(5):573-597. doi: 10.1111/dmcn.15720. Epub 2023 Aug 1.
To evaluate available evidence examining safety and efficacy of non-invasive brain stimulation (NIBS) on upper extremity outcomes in children with cerebral palsy (CP).
We electronically searched 12 sources up to May 2023 using JBI and Cochrane guidelines. Two reviewers selected articles with predetermined eligibility criteria, conducted data extraction, and assessed risk of bias using the Cochrane Risk of Bias criteria.
Nineteen studies were included: eight using repetitive transcranial magnetic stimulation (rTMS) and 11 using transcranial direct current stimulation (tDCS). Moderate certainty evidence supports the safety of rTMS and tDCS for children with CP. Very low to moderate certainty evidence suggests that rTMS and tDCS result in little to no difference in upper extremity outcomes.
Evidence indicates that NIBS is a safe and feasible intervention to target upper extremity outcomes in children with CP, although it also indicates little to no significant impact on upper extremity outcomes. These findings are discussed in relation to the heterogeneous participants' characteristics and stimulation parameters. Larger studies of high methodological quality are required to inform future research and protocols for NIBS.
评估非侵入性脑刺激（NIBS）对上运动神经元损伤后上肢结局的安全性和有效性的证据。
我们根据 JBI 和 Cochrane 指南，对截至 2023 年 5 月的 12 个来源进行了电子搜索。两位评审员根据预定的入选标准选择文章，进行数据提取，并使用 Cochrane 偏倚风险标准评估偏倚风险。
共纳入 19 项研究：8 项使用重复经颅磁刺激（rTMS），11 项使用经颅直流电刺激（tDCS）。有中度确定性证据支持 rTMS 和 tDCS 对脑瘫儿童的安全性。非常低到中度确定性证据表明，rTMS 和 tDCS 对上肢结局几乎没有影响。
证据表明，NIBS 是一种安全且可行的干预措施，可以针对脑瘫儿童的上肢结局进行治疗，尽管它对上肢结局的影响也很小，几乎没有显著影响。这些发现与参与者特征和刺激参数的异质性有关。需要开展高质量的大型研究，为未来的 NIBS 研究和方案提供信息。
