scholarly journals Transcranial Direct Current Stimulation (tDCS) in Unilateral Cerebral Palsy: A Pilot Study of Motor Effect

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Emanuela Inguaggiato ◽  
Nadia Bolognini ◽  
Simona Fiori ◽  
Giovanni Cioni
Keyword(s):  
Cerebral Palsy ◽  
Pilot Study ◽  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Primary Motor Cortex ◽  
Controlled Study ◽  
Anodal Tdcs ◽  
Direct Current Stimulation ◽  
Unilateral Cerebral Palsy

Transcranial Direct Current Stimulation (tDCS) is an emerging tool to improve upper limb motor functions after stroke acquired in adulthood; however, there is a paucity of reports on its efficacy for upper limb motor rehabilitation in congenital or early-acquired stroke. In this pilot study we have explored, for the first time, the immediate effects, and their short-term persistence, of a single application of anodal tDCS on chronic upper limb motor disorders in children and young individuals with Unilateral Cerebral Palsy (UCP). To this aim, in a crossover sham-controlled study, eight subjects aged 10-28 years with UCP underwent two sessions of active and sham tDCS. Anodal tDCS (1.5 mA, 20 min) was delivered over the primary motor cortex (M1) of the ipsilesional hemisphere. Results showed, only following the active stimulation, an immediate improvement in unimanual gross motor dexterity of hemiplegic, but not of nonhemiplegic, hand in Box and Block test (BBT). Such improvement remained stable for at least 90 minutes. Performance of both hands in Hand Grip Strength test was not modified by anodal tDCS. Improvement in BBT was unrelated to participants’ age or lesion size, as revealed by MRI data analysis. No serious adverse effects occurred after tDCS; some mild and transient side effects (e.g., headache, tingling, and itchiness) were reported in a limited number of cases. This study provides an innovative contribution to scientific literature on the efficacy and safety of anodal tDCS in UCP. This trial is registered with NCT03137940.

scholarly journals Treadmill training combined with transcranial direct current stimulation over the primary motor cortex in a child with cerebral palsy and hydrocephalus: A case report.

2014 ◽  
Vol 12 ◽  
pp. 210
Author(s):  
Fernanda Lobo Rezende ◽  
Natália De Almeida Carvalho Duarte ◽  
Luanda André Collange Grecco ◽  
Claudia Santos Oliveira
Keyword(s):  
Cerebral Palsy ◽  
Motor Cortex ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Primary Motor Cortex ◽  
Treadmill Training ◽  
Anodal Tdcs ◽  
Direct Current Stimulation ◽  
Eyes Closed ◽  
Intervention Protocol

Introduction: Transcranial direct current stimulation (tDCS) is a promising technique that stimulates the cortex with a direct, low-intensity electric current and can potentiate motor learning. Objective: Describe the results of an intervention protocol involving anodal stimulation over the primary motor cortex combined with treadmill training in a child with cerebral palsy. Method: The intervention was comprised of ten sessions of anodal tDCS (1mA) over the primary motor cortex during the treadmill training. Stabilometric analysis was evaluated one week before and one week after the intervention. Results: A reduction in oscillations of the COP was found under both conditions (eyes opened and eyes closed. Conclusion: Our findings suggest that anodal tDCS over primary motor cortex can potentiate the results of treadmill training.

scholarly journals Comparison of repeated transcranial stimulation and transcranial direct-current stimulation on primary motor cortex excitability and inhibition: A pilot study

2018 ◽  
pp. 59-67 ◽  
Author(s):  
Vincent Cabibel ◽  
Makii Muthalib ◽  
Jérôme Froger ◽  
Stéphane Perrey
Keyword(s):  
Pilot Study ◽  
Motor Cortex ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
High Definition ◽  
Direct Current Stimulation ◽  
Motor Cortex Excitability ◽  
The Right

Repeated transcranial magnetic stimulation (rTMS) is a well-known clinical neuromodulation technique, but transcranial direct-current stimulation (tDCS) is rapidly growing interest for neurorehabilitation applications. Both methods (contralesional hemisphere inhibitory low-frequency: LF-rTMS or lesional hemisphere excitatory anodal: a-tDCS) have been employed to modify the interhemispheric imbalance following stroke. The aim of this pilot study was to compare aHD-tDCS (anodal high-definition tDCS) of the left M1 (2 mA, 20 min) and LF-rTMS of the right M1 (1 Hz, 20 min) to enhance excitability and reduce inhibition of the left primary motor cortex (M1) in five healthy subjects. Single-pulse TMS was used to elicit resting and active (low level muscle contraction, 5% of maximal electromyographic signal) motor-evoked potentials (MEPs) and cortical silent periods (CSPs) from the right and left extensor carpi radialis muscles at Baseline, immediately and 20 min (Post-Stim-20) after the end of each stimulation protocol. LF-rTMS or aHD-tDCS significantly increased right M1 resting and active MEP amplitude at Post-Stim-20 without any CSP modulation and with no difference between methods. In conclusion, this pilot study reported unexpected M1 excitability changes, which most likely stems from variability, which is a major concern in the field to consider.

Cathodal transcranial direct current stimulation of the primary motor cortex improves selective muscle activation in the ipsilateral arm

2011 ◽  
Vol 105 (6) ◽  
pp. 2937-2942 ◽  
Author(s):  
Alana B. McCambridge ◽  
Lynley V. Bradnam ◽  
Cathy M. Stinear ◽  
Winston D. Byblow
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Muscle Activation ◽  
Primary Motor Cortex ◽  
Selectivity Ratio ◽  
Direct Current Stimulation ◽  
Antagonist Muscles ◽  
Stimulation Of

Proximal upper limb muscles are represented bilaterally in primary motor cortex. Goal-directed upper limb movement requires precise control of proximal and distal agonist and antagonist muscles. Failure to suppress antagonist muscles can lead to abnormal movement patterns, such as those commonly experienced in the proximal upper limb after stroke. We examined whether noninvasive brain stimulation of primary motor cortex could be used to improve selective control of the ipsilateral proximal upper limb. Thirteen healthy participants performed isometric left elbow flexion by contracting biceps brachii (BB; agonist) and left forearm pronation (BB antagonist) before and after 20 min of cathodal transcranial direct current stimulation (c-tDCS) or sham tDCS of left M1. During the tasks, motor evoked potentials (MEPs) in left BB were acquired using single-pulse transcranial magnetic stimulation of right M1 150–270 ms before muscle contraction. As expected, left BB MEPs were facilitated before flexion and suppressed before pronation. After c-tDCS, left BB MEP amplitudes were reduced compared with sham stimulation, before pronation but not flexion, indicating that c-tDCS enhanced selective muscle activation of the ipsilateral BB in a task-specific manner. The potential for c-tDCS to improve BB antagonist control correlated with BB MEP amplitude for pronation relative to flexion, expressed as a selectivity ratio. This is the first demonstration that selective muscle activation in the proximal upper limb can be improved after c-tDCS of ipsilateral M1 and that the benefits of c-tDCS for selective muscle activation may be most effective in cases where activation strategies are already suboptimal. These findings may have relevance for the use of tDCS in rehabilitation after stroke.

scholarly journals Effects of Transcranial Direct Current Stimulation on GABA and Glutamate in Children: A Pilot Study

2019 ◽  
Author(s):  
C Nwaroh ◽  
A Giuffre ◽  
L Cole ◽  
T Bell ◽  
H. L. Carlson ◽  
...  
Keyword(s):  
Skill Acquisition ◽  
Direct Current ◽  
Sensorimotor Cortex ◽  
Transcranial Direct Current Stimulation ◽  
Primary Motor Cortex ◽  
Therapeutic Potential ◽  
Fine Motor ◽  
Resonance Spectroscopy ◽  
Anodal Tdcs ◽  
Direct Current Stimulation

AbstractTranscranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that safely modulates brain excitability and has therapeutic potential for many conditions. Several studies have shown that anodal tDCS of the primary motor cortex (M1) facilitates motor learning and plasticity, but there is little information about the underlying mechanisms. Using magnetic resonance spectroscopy (MRS) it has been shown that tDCS can affect local levels of γ-aminobutyric acid (GABA) and Glx (a measure of glutamate and glutamine combined) in adults, both of which are known to be associated with skill acquisition and plasticity; however this has yet to be studied in children and adolescents. This study examined GABA and Glx in response to conventional anodal tDCS (a-tDCS) and high definition tDCS (HD-tDCS) targeting the M1 in a pediatric population. Twenty-four typically developing, right handed children ages 12–18 years participated in five consecutive days of tDCS intervention (sham, a-tDCS or HD-tDCS) targeting the right M1 while training in a fine motor task (Purdue Pegboard Task) with their left hand. Glutamate and GABA were measured before and after the protocol (at day 5 and 6 weeks) using conventional MRS and GABA-edited MRS in the sensorimotor cortices. Glutamate measured in the left sensorimotor cortex was higher in the HD-tDCS group compared to a-tDCS and sham at 6 weeks (p = 0.001). No changes in GABA were observed in either sensorimotor cortex at any time. These results suggest that neither a-tDCS or HD-tDCS locally affect GABA and glutamate in the developing brain and therefore it may demonstrate different responses in adults.

scholarly journals Differences in high-definition transcranial direct current stimulation over the motor hotspot versus the premotor cortex on motor network excitability

2018 ◽  
Author(s):  
Stephanie Lefebvre ◽  
Kay Jann ◽  
Allie Schmiesing ◽  
Kaori Ito ◽  
Mayank Jog ◽  
...  
Keyword(s):  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Primary Motor Cortex ◽  
Premotor Cortex ◽  
Controlled Study ◽  
High Definition ◽  
Promising Alternative ◽  
Direct Current Stimulation ◽  
Motor Network ◽  
Motor Excitability

AbstractThe effectiveness of transcranial direct current stimulation (tDCS) placed over the motor hotspot (thought to represent the primary motor cortex (M1)) to modulate motor network excitability is highly variable. The premotor cortex—particularly the dorsal premotor cortex (PMd)—may be a promising alternative target to more effectively modulate motor excitability, as it influences motor control across multiple pathways, one independent of M1 and one with direct, modulating connections to M1. This double-blind, placebo-controlled study aimed to differentially excite motor and premotor regions using high-definition tDCS (HD-tDCS) with concurrent functional magnetic resonance imaging (fMRI). HD-tDCS applied over either the motor hotspot or the premotor cortex demonstrated high inter-individual variability in changes on cortical motor excitability. However, HD-tDCS over the premotor cortex led to a higher number of responders and greater changes in local fMRI-based complexity than HD-tDCS over the motor hotspot. Furthermore, an analysis of individual motor hotspot anatomical locations revealed that, in more than half of the participants, the motor hotspot is not located over anatomical M1 boundaries, despite using a canonical definition of the motor hotspot. This heterogeneity in stimulation site may contribute to the variability of tDCS results. Altogether, these findings provide new considerations to enhance tDCS reliability.

Transcranial direct current stimulation for children with perinatal stroke and hemiparesis

Neurology ◽  
2016 ◽  
Vol 88 (3) ◽  
pp. 259-267 ◽  
Author(s):  
Adam Kirton ◽  
Patrick Ciechanski ◽  
Ephrem Zewdie ◽  
John Andersen ◽  
Alberto Nettel-Aguirre ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Motor Learning ◽  
Motor Function ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Primary Motor Cortex ◽  
Intensive Therapy ◽  
Performance Measure ◽  
Perinatal Stroke ◽  
Direct Current Stimulation

Objective:To determine whether the addition of transcranial direct current stimulation (tDCS) to intensive therapy increases motor function in children with perinatal stroke and hemiparetic cerebral palsy.Methods:This was a randomized, controlled, double-blind clinical trial. Participants were recruited from a population-based cohort with MRI-classified unilateral perinatal stroke, age of 6 to 18 years, and disabling hemiparesis. All completed a goal-directed, peer-supported, 2-week after-school motor learning camp (32 hours of therapy). Participants were randomized 1:1 to 1 mA cathodal tDCS over the contralesional primary motor cortex (M1) for the initial 20 minutes of daily therapy or sham. Primary subjective (Canadian Occupational Performance Measure [COPM]), objective (Assisting Hand Assessment [AHA]), safety, and secondary outcomes were measured at 1 week and 2 months after intervention. Analysis was by intention to treat.Results:Twenty-four participants were randomized (median age 11.8 ± 2.7 years, range 6.7–17.8). COPM performance and satisfaction scores doubled at 1 week with sustained gains at 2 months (p < 0.001). COPM scores increased more with tDCS compared to sham control (p = 0.004). AHA scores demonstrated only mild increases at both time points with no tDCS effects. Procedures were safe and well tolerated with no decrease in either arm function or serious adverse events.Conclusion:tDCS trials appear feasible and safe in hemiparetic children. Lack of change in objective motor function may reflect underdosing of therapy. Marked gains in subjective function with tDCS warrant further study.ClinicalTrials.gov identifier:NCT02170285.Classification of evidence:This study provides Class II evidence that for children with perinatal stroke and hemiparetic cerebral palsy, the addition of tDCS to moderate-dose motor learning therapy does not significantly improve motor function as measured by the AHA.

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