http://onlinelibrary.wiley.com/doi/10.1111/dmcn.12243/abstract?
- Abstract
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Aim
The
aim of this study was to determine the feasibility and efficacy of five
treatments of 6 Hz primed, low-frequency, repetitive transcranial
magnetic stimulation (rTMS) combined with constraint-induced movement
therapy (CIMT) to promote recovery of the paretic hand in children with
congenital hemiparesis.
Method
Nineteen
children with congenital hemiparesis aged between 8 and 17 years (10
males, nine females; mean age 10 years 10 months, SD 2 years 10 months;
Manual Ability Classification Scale levels I-III) underwent five
sessions of either real rTMS (n=10) or sham rTMS (n=9)
alternated daily with CIMT. CIMT consisted of 13 days of continuous
long-arm casting with five skin-check sessions. Each child received a
total of 10 hours of one-to-one therapy. The primary outcome measure was
the Assisting Hand Assessment (AHA) and the secondary outcome variables
were the Canadian Occupational Performance Measure (COPM) and
stereognosis. A Wilcoxon signed-rank sum test was used to analyze
differences between pre- and post-test scores within the groups.
Analysis of covariance was used to compute mean differences between
groups adjusting for baseline. Fisher's exact test was used to compare
individual change in AHA raw scores with the smallest detectable
difference (SDD) of 4 points.
Results
All participants receiving treatment finished the study. Improvement in AHA differed significantly between groups (p=0.007).
No significant differences in the secondary outcome measures were
found. Eight out of 10 participants in the rTMS/CIMT group showed
improvement greater than the SDD, but only two out of nine in the sham
rTMS/CIMT group showed such improvement (p=0.023). No serious adverse events occurred.
Interpretation
Primed,
low-frequency rTMS combined with CIMT appears to be safe, feasible, and
efficacious in pediatric hemiparesis. Larger clinical trials are now
indicated.
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