Long Term Effects of 5-Hz rTMS over M1 Cortex in Spastic Cerebral Palsy: A Pilot Randomized Controlled Trial
Atchara Boonmeeprakob, Somrot Phonglamai, Suttipong Tipchatyotin*
Department of Rehabilitation Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; Email: tsuttipo@medicine.psu.ac.th
Objectives: To determine long term effect of repetitive transcranial magnetic stimulation (rTMS) on muscle tone reduction and mobility in children with spastic cerebral palsy (CP).
Study design: A pilot randomized controlled trial.
Setting: Southern Rehabilitation Center, Songklanagarind Hospital.
Subjects: Spastic CP aged 5-18 years old with modified Ash-worth Scale (MAS) of extremities graded 1 to 3.
Methods: Participants were randomized into 2 groups, rTMS and sham groups. The rTMS group received 1500 stimuli of 5-Hz stimulation, 90% resting motor threshold stimulation over the primary motor cortex for 10 consecutive working days. The sham group received 10% resting motor threshold intensity over the same area and duration of stimulation. Both groups received a standard rehabilitation program during experimental periods. Outcome  measurements  included  MAS  of  extremity  muscles  and  joint  range  of  motion  (ROM)  at  angle  of  catch  (Tardieu’s  R1) for muscle tone and the Gross Motor Function Classification System  -  expanded  and  revised  (GMFCS-ER)  Thai  version  for  mobility,  were  assessed  before  intervention,  immediately  after  intervention, and follow up at 1, 2, 4 and 8 weeks after the last treatment session.
Results: Eighteen children were recruited, mean age (SD) was 95.9 (31.7) months in the rTMS group and 93.8 (20.4) months in the sham group. Their GMFCS-ER was classified as level 3 to 5. After completion of 10 sessions, there were no significant changes in MAS.  ROMs at angle of catch tended to increase post intervention and during follow up period in the rTMS group. Mobility levels according to GMFCS-ER were constant within group and no difference between groups. No serious adverse event was reported entire this study.
Conclusion:  5-Hz  rTMS over the primary motor cortex for 10 days had no additive effects of spasticity or muscle tone reduction or functional improvement in children with  spastic  cerebral  palsy.
Asean Journal of Rehabilitation Medicine ปี 2564, May-August ปีที่: 31 ฉบับที่ 2 หน้า 46-52
Spasticity, Cerebral palsy, repetitive transcranial magnetic stimulation