Authors: (including presenting author): :
Fan CY(1), Ho WS(3), Cheng KF(3), Lau SN(3), Tso WY(1)(2)*
Affiliation: :
(1) Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, (2) Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, (3) Department of Neurosurgery, Queen Mary Hospital, The University of Hong Kong *Corresponding author
Keyword 4: :
Brain Injury
Introduction: :
Hemiplegia is a common sequela after acquired brain injury (ABI), affecting daily functioning and quality of life. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that modulates cortical excitability, thereby improving motor symptoms.
Objectives: :
To test whether combining inhibitory, low-frequency rTMS followed by motor learning exercises is a safe and effective approach to enhance motor function recovery in children with hemiplegia secondary to ABI.
Methodology: :
Patients aged between 4 and 18 years with upper or lower extremity impairment due to ABI were eligible. Exclusion criteria included severe spasticity (Modified Ashworth Scale =4), uncontrollable epilepsy, and a history of Botulinum toxin A injection within the preceding six months. In this double-blind, sham-controlled randomized controlled trial, 18 children with hemiplegia due to brain injury were allocated to receive either inhibitory, low-frequency rTMS over contra-lesional motor cortex (20 min, 1200 pulses) or sham treatment followed by 1-hour PT/OT-guided motor learning exercises, for 10 consecutive daily sessions with a weekend break. Motor function was assessed by an occupational therapist using the Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition (BOT-2) at baseline, immediately post-intervention (Day 10), and follow-up (Day 17). A difference-in-differences (DID) analysis was conducted to assess whether rTMS combined with training led to greater improvements in motor performance in children with hemiplegia compared to training alone.
Result & Outcome: :
18 patients with hemiplegia due to brain injury were enrolled (mean age at treatment 11.8 [SD 4.0] years; mean follow-up time 6.2 [SD 4.5] years). A 10-day inhibitory, low-frequency rTMS treatment followed by motor training led to a significant change in total motor composite (TMC) between treatment and sham groups across the three time points. From baseline to day 10, the treatment group showed a significantly greater increase in TMC compared to the sham group (DID estimate 11.95 units, p=.027). The effect size was large (d =4.46). The treatment effect persisted one-week post-treatment, with the treatment group demonstrating a significantly greater and sustained increase in TMC from day 10 to day 17 (DID estimate 11.05 units, p=.047). The effect size was large (d= 2.86). rTMS was reported to be well tolerated, with no occurrences of serious adverse events. The combination of contra-lesional, inhibitory rTMS and motor learning exercises is safe and effective in enhancing overall motor function in children with hemiplegia after ABI.
