scholarly journals Telomere Length Changes in Children With Cushing Disease: A Pilot Study

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Christina Tatsi ◽  
Chelsi Flippo ◽  
Fabio R Faucz ◽  
Ninet Sinaii ◽  
Constantine A Stratakis
Keyword(s):  
Blood Pressure ◽  
Pilot Study ◽  
Telomere Length ◽  
Pediatric Patients ◽  
Inverse Correlation ◽  
Cushing Disease ◽  
Total Lymphocyte ◽  
Length Changes ◽  
Active Disease

Abstract Context Changes in telomere length (TL) have been linked to certain diseases. Studies on the effect of cortisol on TL have not led to conclusive results. Objective To determine whether TL is affected in pediatric patients with Cushing disease (CD) through an exploratory study. Design We studied 10 pediatric patients [mean age: 13.3 (2.6) years, 7 females], diagnosed and treated successfully for CD. TL was measured before and approximately 1 year after treatment. TL was compared with controls adjusting for age, and associations with disease characteristics were assessed. Results Adjusting for age, total lymphocyte TL of patients did not differ from controls during active disease (P = 0.13) but was shorter than controls at follow-up (P = 0.031). Total lymphocyte TL during active CD and at follow-up did not correlate with markers of hypercortisolemia. There was strong inverse correlation between TL during active disease and at follow-up with triglyceride levels at active disease (adjusted [Adj] R2 = 0.64; P = 0.02 and Adj R2 = 0.5; P = 0.036, respectively), suggesting that the higher the triglycerides, the shorter the TL in patients with CD. The change of TL between active disease and follow-up was positively correlated with systolic blood pressure (Adj R2 = 0.76; P = 0.006). Conclusions In this pilot study, TL is shorter in children with hypercortisolemia, a difference that becomes detectable only after cure of CD. Triglycerides and blood pressure appear to be factors that are associated with TL in these patients. Further studies are required to confirm these results.

scholarly journals Presentation, Treatment, Histology, and Outcomes in Adrenal Medullary Hyperplasia Compared With Pheochromocytoma

2019 ◽  
Vol 3 (8) ◽  
pp. 1518-1530 ◽  
Author(s):  
Henrik Falhammar ◽  
Adam Stenman ◽  
Jan Calissendorff ◽  
Carl Christofer Juhlin
Keyword(s):  
Blood Pressure ◽  
Surgical Management ◽  
Cushing Syndrome ◽  
Adrenocortical Adenoma ◽  
Cushing Disease ◽  
Genetic Syndrome ◽  
Alpha Blockers ◽  
Adrenal Medullary Hyperplasia ◽  
Symptoms And Signs

Abstract Context Information about adrenal medullary hyperplasia (AMH) is scarce. Objective To study a large cohort of AMHs. Design, Setting, and Participants Nineteen AMH cases were compared with 95 pheochromocytomas (PCCs) without AMH. AMH without (n = 7) and with PCC (n = 12) were analyzed separately. Results Of 936 adrenalectomies, 2.1% had AMH. Mean age was 47.2 ± 15.1 years. Only two (11%) AMHs had no concurrent PCC or adrenocortical adenoma. In AMHs, a genetic syndrome was present in 58% vs 4% in PCCs (P < 0.001). The noradrenaline/metanephrine levels were lower in AMHs, whereas suppression of dexamethasone was less than in PCCs. Cushing syndrome was found in 11% of AMHs. More AMHs were found during screening and less as incidentalomas. PCC symptoms were less prevalent in AMHs. Surgical management was similar; however, fewer of the AMHs were pretreated with alpha-blockers. Adrenalectomy improved blood pressure slightly less in AMHs. The disappearance of glycemic disturbances was similar to the PPCs. During a period of 11.2 ± 9.4 years, a new PCC developed in 32% of patients with AMH, 11% died, but no PCC metastasis occurred (PCCs: 4%, P < 0.001; 14% and 5%). AMHs without PCC had milder symptoms but more often Cushing disease than patients with PCC, whereas AMH with PCC more often displayed a familiar syndrome with more PCC recurrences. Conclusion A total of 2.1% of all adrenalectomies displayed AMH. AMH seemed to be a PCC precursor. The symptoms and signs were milder than PCCs. AMHs were mainly found due to screening. Outcomes seemed favorable, but new PCCs developed in many during follow-up.

scholarly journals Evaluation of Monitoring for Metabolic Effects in Children Treated With Second Generation Antipsychotics in a Pediatric Clinic

2013 ◽  
Vol 18 (4) ◽  
pp. 292-297 ◽  
Author(s):  
Brooke L. Honey ◽  
Lourdes Ramos ◽  
Nancy C. Brahm
Keyword(s):  
Blood Pressure ◽  
Patient Care ◽  
Second Generation ◽  
Pediatric Patients ◽  
Metabolic Effects ◽  
Inclusion Criteria ◽  
Antipsychotic Therapy ◽  
Antipsychotic Medications ◽  
Pediatric Clinic

OBJECTIVES The aim of this retrospective study was to identify the frequency of recommended metabolic monitoring and follow-up in pediatric patients on second-generation antipsychotic (SGA) medications from a pediatric clinic. METHODS A retrospective review of electronic medical records of all patients on antipsychotics from an academic medical center pediatric clinic was conducted. Inclusion criteria required patients to be established members of the pediatric clinic, &lt; 19 years of age, and on ≥ 1 SGA for at least 1 year, regardless of medical diagnosis. Data collection consisted of patient demographic information and frequency of family history, vital signs, and recommended laboratory monitoring. RESULTS A total of 67 patients on antipsychotics were identified. After the application of inclusion criteria, 32 patients qualified for review. The average age was 13.5 ± 4 years and gender distribution included 72% males. Only 4 (13%) patients had documented baseline monitoring that included weight, blood pressure, and fasting lipid panel. No patient had a fasting plasma glucose recorded at any point during antipsychotic therapy. Follow-up monitoring decreased over time, with the exception of quarterly weight and annual blood pressure. CONCLUSIONS The results of this study highlight the lack of baseline and periodic monitoring that occur when pediatric patients are prescribed antipsychotic medications, putting the patient at risk for adverse events. The marked increase in antipsychotic prescribing and concerns related to their safety emphasize the need for improvement in monitoring of antipsychotic medications. This gap in patient care and safety opens an excellent opportunity for a clinical pharmacy team to provide education and assistance with SGA monitoring for the purpose of providing optimal patient care.

scholarly journals Understanding the Feasibility, Acceptability, and Efficacy of a Clinical Pharmacist-led Mobile Approach (BPTrack) to Hypertension Management: Mixed Methods Pilot Study

10.2196/19882 ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. e19882
Author(s):  
Lorraine R Buis ◽  
Dana N Roberson ◽  
Reema Kadri ◽  
Nicole G Rockey ◽  
Melissa A Plegue ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pilot Study ◽  
Clinical Pharmacist ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Uncontrolled Hypertension ◽  
Hypertension Management ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring

Background Hypertension is a prevalent and costly burden in the United States. Clinical pharmacists within care teams provide effective management of hypertension, as does home blood pressure monitoring; however, concerns about data quality and latency are widespread. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology. Objective We sought to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that incorporates patient- and clinician-facing apps to make electronically collected, patient-generated data available to providers in real time for hypertension management. The patient app also included customizable daily medication reminders and educational messages. Additionally, this study sought to understand barriers to adoption and areas for improvement identified by key stakeholders, so more widespread use of such interventions may be achieved. Methods We conducted a mixed methods pilot study of BPTrack, to improve blood pressure control in patients with uncontrolled hypertension through a 12-week pre-post intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for hypertension management. Participants completed a baseline visit, then spent 12 weeks utilizing BPTrack before returning to the clinic for follow-up. Collected data from patient participants included surveys pre- and postintervention, clinical measures (for establishing effectiveness, with the primary outcome being a change in blood pressure and the secondary outcome being a change in medication adherence), utilization of the BPTrack app, interviews at follow-up, and chart review. We also conducted interviews with key stakeholders. Results A total of 15 patient participants were included (13 remained through follow-up for an 86.7% retention rate) in a single group, pre-post assessment pilot study. Data supported the hypothesis that BPTrack was feasible and acceptable for use by patient and provider participants and was effective at reducing patient blood pressure. At the 12-week follow-up, patients exhibited significant reductions in both systolic blood pressure (baseline mean 137.3 mm Hg, SD 11.1 mm Hg; follow-up mean 131.0 mm Hg, SD 9.9 mm Hg; P=.02) and diastolic blood pressure (baseline mean 89.4 mm Hg, SD 7.7 mm Hg; follow-up mean 82.5 mm Hg, SD 8.2 mm Hg; P<.001). On average, patients uploaded at least one blood pressure measurement on 75% (SD 25%) of study days. No improvements in medication adherence were noted. Interview data revealed areas of improvement and refinement for the patient experience. Furthermore, stakeholders require integration into the electronic health record and a modified clinical workflow for BPTrack to be truly useful; however, both patients and stakeholders perceived benefits of BPTrack when used within the context of a clinical relationship. Conclusions Results demonstrate that a pharmacist-led mHealth intervention promoting home blood pressure monitoring and clinical pharmacist management of hypertension can be effective at reducing blood pressure in primary care patients with uncontrolled hypertension. Our data also support the feasibility and acceptability of these types of interventions for patients and providers. Trial Registration ClinicalTrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8059

scholarly journals MON-190 Telomere Length as a Novel Prognostic Marker of Cushing Complications

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Christina Tatsi ◽  
Fabio Rueda Faucz ◽  
Chelsi Flippo ◽  
Ninet Sinaii ◽  
Constantine A Stratakis
Keyword(s):  
T Cells ◽  
B Cell ◽  
Telomere Length ◽  
Prognostic Marker ◽  
Pediatric Patients ◽  
Nk Cell ◽  
Cushing Syndrome ◽  
Statistical Tests ◽  
Inverse Correlation ◽  
Free Cortisol

Abstract Telomeres are small sequences at the end of chromosomes, protecting them from abnormal degradation. Certain conditions, like cancer, have been associated with changes in telomere length (TL), which, in turn, may predict outcomes of the disease. Studies on the effect of cortisol on TL have not led to conclusive results or are limited in stress induced hypercortisolemia. Moreover, no study has focused on effects of persistent endogenous hypercortisolemia during childhood, a known important period for telomere modifications. We hypothesized that TL is affected in pediatric patients with endogenous Cushing syndrome (CS) and it correlates with markers and complications of hypercortisolemia. We studied 10 pediatric patients (mean age: 13.3 years, 7 females), diagnosed and treated successfully for Cushing disease. TL of total lymphocytes and their subtypes (Naïve T-cells, Memory T-cells, B-cells and NK-cells) were measured before and 1 year after treatment. TL was compared to age-matched control samples (6-8 per age group) and was correlated with clinical and biochemical characteristics. Paired or two-sample parametric or non-parametric statistical tests were performed, as appropriate. Lymphocyte TL of patients with active CS did not differ from controls (p=.43). B-cell and NK-cell TLs were shorter after cure compared to active CS [mean B-cell TL difference: -1.44 Kb (-15%), p=.001; mean NK-cell difference: -0.51 Kb (-7%), p=.10] and controls [mean B-cell TL difference: -0.98 (-11%), p=.039; mean NK-cell difference: -1.3 Kb (-16%), p=.005]. Lymphocyte TL in active CS and the change of TL before and after cure did not correlate with measured markers of hypercortisolemia (morning and midnight cortisol, urinary free cortisol or ACTH levels). However, there was a strong inverse correlation between the difference of TL in active disease compared to controls and triglyceride level for all lymphocyte subtypes (range r= -0.74 to -0.86, range p= .003 to p=.022), suggesting that the higher the triglyceride levels, the shorter the TL in patients with CS. Additionally, inverse correlation was observed for weight and BMI SDS and B-cell TL, specifically (r= -0.76, p= .019 and r= -0.76, p= .018, respectively). Furthermore, there appeared to be an implication for shorter TL in CS patients with dyslipidemia compared to those without (mean TL difference from controls: -1.1 Kb in patients with dyslipidemia vs 0.53 Kb in those without, p= .067). We conclude that although TL in active CS does not seem to differ from controls, B-cell and NK-cell TLs are affected after cure, and this may be related to acute changes that occur in the immune system peri- and post-operatively. Interestingly, the level of TL shortening correlates strongly with several complications of CS, including weight, BMI and dyslipidemia. This suggests that TL may be used as a surrogate prognostic marker of hypercortisolemia-related complications.

Improved Sleep Quality Improves Blood Pressure Control among Patients with Chronic Kidney Disease: A Pilot Study

2020 ◽  
Vol 51 (3) ◽  
pp. 249-254 ◽  
Author(s):  
Waleed Ali ◽  
Guimin Gao ◽  
George L. Bakris
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Pilot Study ◽  
Kidney Disease ◽  
Sleep Quality ◽  
Resistant Hypertension ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
The Impact

Background: Despite the abundance of data documenting the consequences of poor sleep quality on blood pressure (BP), no previous study to our knowledge has addressed the impact of sleep improvement on resistant hypertension among patients with chronic kidney disease (CKD). Methods: The aim of this pilot study was to determine whether improved sleep quality and duration will improve BP control in patients with resistant hypertension and CKD. It was a prospective single-center cohort study that involved 30 hypertensive subjects with CKD presenting with primary resistant hypertension and poor sleep quality or duration <6 h/night. Sleep quality and duration were modified using either sleep hygiene education alone or adding sleep medication. The cohort’s BP was followed every 3 months for 6-month duration. The average home and clinic BPs were collected at each follow-up visit. The primary outcome baseline change in systolic BP (SBP) and diastolic BP (DBP; home and clinic) at 3 and 6 months after documented sleep improvement. Secondary outcomes included change from baseline in mean arterial pressure, and delta SBP after sleep improvement. Results: African American patients represented 50% of the cohort. All patients had evidence of CKD with GFR ≤60 mL/min and were obese with 40% having type 2 diabetes mellitus. The primary endpoint of change in clinic SBP and DBP was significantly reduced at 3 months, baseline 156 ± 15/88 ± 8 vs. 3 months 125 ± 14/73 ± 7 (p < 0.0001). This difference persisted at 6 months. However, there was no further reduction in-home or clinic BPs between the 3- and 6-month periods. Home and clinic average delta SBP change at 3 months from baseline was –34.4 ± 15 and –30.8 ± 19 mm Hg respectively. Delta SBP change was associated with sleep improvement of >6 h/night, that is, gaining an extra 3–4 h’ sleep duration, home; R2 = 0.66, p < 0.0001 and clinic; R2 = 0.49, p < 0.0001. Conclusion: Optimizing sleep quality and duration to >6 h/night improved BP control and was associated with a significant delta change in SBP within 3 months of follow-up. Physicians should obtain a sleep history in patients with CKD who present with resistant hypertension.

Association between favourable changes in objectively measured physical activity and telomere length after a lifestyle intervention in pediatric patients with abdominal obesity.

2020 ◽  
Author(s):  
Ana Ojeda-Rodríguez ◽  
Lydia Morell-Azanza ◽  
Nerea Martín-Calvo ◽  
Guillermo Zalba ◽  
María Chueca ◽  
...  
Keyword(s):  
Physical Activity ◽  
Telomere Length ◽  
Lifestyle Intervention ◽  
Abdominal Obesity ◽  
Usual Care Group ◽  
Pediatric Patients ◽  
Intervention Group ◽  
Care Group ◽  
Intensive Phase

The purpose of this study was to assess the effect of physical activity (PA) changes, measured by accelerometry, on telomere length (TL) in pediatric patients with abdominal obesity after a lifestyle intervention. 121 children with abdominal obesity (7-16 years old) were randomized to the intervention (moderately hypocaloric Mediterranean Diet) or usual care group (standard pediatrics recommendations) for 22 months (a 2-month intensive phase and a subsequent 20-month follow-up). Both groups were encouraged to accumulate extra 200 min/week of PA. TL was measured by MMqPCR. Data were analyzed in 102 subjects after 2-month and 64 subjects at the first 10 months of follow-up. Light PA level decreased in both groups after 12-month of intervention. At month 2, moderate-to-vigorous PA (MVPA) incremented in the intervention group (+5.4 min/day, p=0.035) and so did sedentary time in the usual care group (+49.7 min/day, p=0.010). TL changes were positively associated (p<0.050) with metabolic equivalents (METs), MVPA level and number of steps; and inversely associated with sedentary and light PA levels in the intervention group after the intensive phase. In conclusion, favourable changes in PA levels in the intensive phase of a lifestyle intervention could contribute to TL maintenance in pediatric population with abdominal obesity. Novelty: • Changes in physical activity levels had a direct effect on telomere length, a biomarker of cellular aging and oxidative stress. • PA advice based on The American College of Sports Medicine included in this intervention is easy to implement in primary care.

scholarly journals Hypertension-related factors in patients with active and inactive acromegaly

2011 ◽  
Vol 55 (7) ◽  
pp. 468-474 ◽  
Author(s):  
Daniela Fedrizzi ◽  
Ticiana Costa Rodrigues ◽  
Fabíola Costenaro ◽  
Rosana Scalco ◽  
Mauro Antônio Czepielewski
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Cross Sectional Study ◽  
Related Factors ◽  
Cross Sectional ◽  
Positive Correlation ◽  
Lower Blood ◽  
Active Acromegaly ◽  
Active Disease

INTRODUCTION: There are several complications of the cardiovascular system caused by acromegaly, especially hypertension. OBJECTIVES: To evaluate hypertension characteristics in patients with cured/controlled acromegaly and with the active disease. PATIENTS AND METHODS: Cross-sectional study of the follow-up of forty-four patients with acromegaly submitted to clinical evaluation, laboratory tests and cardiac ultrasound. Patients with cured and controlled disease were evaluated as one group, and individuals with active disease as second one. RESULTS: Forty-seven percent of the patients had active acromegaly, and these patients were younger and had lower blood pressure levels than subjects with controlled/cured disease. Hypertension was detected in 50% of patients. Subjects with active disease showed a positive correlation between IGF-1 and systolic and diastolic blood pressure levels (r = 0.48, p = 0.03; and r = 0.42, p = 0.07, respectively), and a positive correlation between IGF-1 and urinary albumin excretion (UAE) rates. In patients with active disease, IGF-1 was a predictor of systolic blood pressure, although it was not independent of UAE rate. For individuals with cured/controlled disease, waist circumference and triglycerides were the predictors associated with systolic and diastolic blood pressure. CONCLUSIONS: Our findings suggest that blood pressure levels in patients with active acromegaly are very similar, and depend on excess GH. However, once the disease becomes controlled and IGF-1 levels decrease, their blood pressure levels will depend on the other cardiovascular risk factors.

P1693The longitudinal associations between telomere attrition and the effects of blood pressure lowering and antihypertensive treatment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Y Zhang ◽  
R X Li ◽  
Y Y Yang ◽  
Y Chen ◽  
S J Yang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Telomere Length ◽  
Antihypertensive Treatment ◽  
Attrition Rate ◽  
Leukocyte Telomere Length ◽  
Blood Pressure Lowering ◽  
Blood Samples ◽  
Telomere Attrition ◽  
Pressure Lowering

Abstract Background Leukocyte telomere length, as an emerging marker of biological age, has been shown to associate with hypertension. However, it has not been studied whether telomere attrition rate in patients with hypertension is related to the heterogeneity of blood pressure (BP) response to antihypertensive therapy. Purpose Our aim is to investigate the relationship between telomere attrition rate and BP lowering in a longitudinal Chinese hypertensive cohort. We also aim to explore the potential association between telomere attrition rate and the differences in antihypertensive treatment response. Methods A community-based, prospective study was conducted at BenXi county, Liaoning province, in the northern China. A total of 3,671 hypertensive patients were recruited from 2013 t 2015 and of whom 1,382 provided blood samples at baseline. After a median follow-up period of 2.2 (range 1.5–2.4) years, the blood samples were collected from 1,197 patients again in 2016, and 185 patients were not reached to obtain blood sample because of immigration. In addition, 89 blood samples were excluded due to insufficient quality. Finally, 1,108 patients who are available for blood samples both at baseline and at follow-up, were included in the analysis for telomeres change. Annual telomere attrition rate was calculated as (follow-up telomere length-baseline telomere length)/follow-up year, and then categorized into two groups: the shorten (annual telomere attrition rate <0) and the lengthen (annual telomere attrition rate >0). Multivariable linear regression model was used to examine the association of annual telomere attrition rate with blood pressure lowering and antihypertensive treatment. Cox Proportional Hazards model was used to examine the association between annual telomere attrition rate and cardiovascular disease risk. Results In multivariable linear regression models, the telomere lengthening was significantly associated with decrease in systolic blood pressure (SBP) (β: −4.13; p=0.006) and pulse pressure (PP) (β: −3.22; p=0.007) during the follow-up, but not associated with diastolic blood pressure (DBP) change. And the associations were observed age- and gender-specific difference. The lengthen was significantly associated with ΔSBP and ΔPP in women and younger patients (age ≤60 years old). Furthermore, the associations were observed in patients who treated with calcium channel blocker (CCB) and angiotensin receptor blocker (ARB), but not in diuretics. Then we found no significant association between annual telomere attrition rate and incident cardiovascular events during the follow-up. Conclusion(s) Our data showed that the increasing of leukocyte telomere length is associated with the decreasing of SBP and PP, particularly for the patients who received CCB and ARB therapy. These data showed that annual telomere attrition rate could be a marker of treatment response and will help in clinical management. Acknowledgement/Funding the National Science and Technology Pillar Program during the Twelfth Five-year Plan Period (No. 2011BAI11B04)

scholarly journals Feasibility of single and combined with other treatments using transcranial direct current stimulation for chronic stroke: A pilot study

2020 ◽  
Vol 8 ◽  
pp. 205031212094054
Author(s):  
Koichi Hyakutake ◽  
Takashi Morishita ◽  
Kazuya Saita ◽  
Toshiyasu Ogata ◽  
Yoshinari Uehara ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Botulinum Toxin ◽  
Pilot Study ◽  
Transcranial Direct Current Stimulation ◽  
Pediatric Patients ◽  
Botulinum Toxin A ◽  
Neuromuscular Electrical Stimulation ◽  
Chronic Stroke ◽  
Group I

Objectives: This pilot study aimed to investigate the safety and efficacy of transcranial direct current stimulation (tDCS) for chronic stroke in adult and pediatric patients. We also aimed to verify the efficacy of botulinum toxin A and peripheral neuromuscular electrical stimulation combined therapy involving bilateral tDCS in adult patients with chronic stroke. Methods: We conducted a pilot study applying an unblinded, non-randomized design. Eleven patients were recruited, and classified into three groups. Group I-a involved bilateral transcranial direct current stimulation and intensive occupational therapy for chronic stroke in adult patients. Group I-b involved bilateral tDCS and intensive occupational therapy for chronic stroke in pediatric patients. Group II involved bilateral tDCS, peripheral neuromuscular electrical stimulation, and intensive occupational therapy after botulinum toxin A injection for chronic stroke in adult patients. Clinical evaluations to assess motor function and spasticity were performed at baseline as well as in 2-week and 4-month follow-up visits. The questionnaire included questions regarding the presence of tDCS side effects, such as headache, redness, pain, itching, and fever. Results: There were clinically meaningful changes in total Fugl–Meyer Assessment Upper Extremity (FMA-UE) scores at the 2-week follow-up and in the Action Research Arm Test (ARAT) scores at 4-month follow-up in Group I-b. In addition, Group II showed significant improvement in total FMA-UE scores in the 2-week follow-up (p < 0.05) but not on the ARAT scores (p > 0.05). However, Group II showed improvements in total Motor Activity Log scores at both follow-up visits (p < 0.05). No serious adverse events were reported. Conclusion: The results of this study indicate that tDCS therapy is a potential treatment in pediatric patients with chronic stroke. Furthermore, our data indicate that botulinum toxin A and peripheral neuromuscular electrical stimulation combined therapy may enhance the efficacy of tDCS on motor function.

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