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Motor reorganisation with transcranial stimulation of motor cortex in children with hemiplegic cerebral palsy


Physical medicine & Rehabilitation, Research Institute of Clinical Medicine, and Institute for Medical Science, Chonbuk National University Medical School, Jeonju, South Korea

Background/Objectives: Transcranial motor cortex stimulation (TMS) has been used to elicit responses in arm and leg muscles under various pathological conditions. TMS proved as a valuable, non-invasive neurophysiological tool to investigate motor reorganization in neurological patients. This study was aimed to analyze patterns of abnormalities in the fastest corticomotoneuronal connections by stimulation of motor cortex in patients with hemiplegic cerebral palsy.

Design: Prospectively assessed collected data

Participants and Setting: Participants: Fifteen patients with hemiplegic CP were enrolled. Their mean age was 8.5 ± 2.8 years. Setting: Institutional tertiary care ambulatory clinic

Materials/Methods: MRI and clinical assessment were performed. Transcranial magnetic stimulation (TMS) was applied to each motor cortices in turn and bilateral electromyographic recordings were made from 1st dorsal interossei muscles with the patients being as relaxed as possible. The onset latency and peak-to-peak amplitude of motor evoked potential were measured for each muscle on both sides.

Results: According to lesion localization by the MRI scan and the outcome of TMS, patient data were subdivided into 3 groups: (I) clinical presentation corresponded to a focal lesion in the corticospinal tract as defined above the TMS showed a pathological pattern. (II) Patients with clinical hemiparesis and pathological TMS but without focal lesions of the corticospinal tract on the MRI scan. (III) Normal TMS and MRI findings despite evidence of a clinical presentation of hand motor disturbance. Group I consisted of 10 children. TMS findings of group I reveal 5 different motor reorganization patterns observed in lesional and contralesional hemispheres. Bilateral signs of brain lesion by the MRI scan manifested in unilateral motor involvement. Group II consisted of 2 patients and group III has 1 patient.

Conclusions/Significance: The presenting study shows that TMS may also provide useful information for diagnosis of motor disturbance in children. TMS of motor cortex in children has provided insight into the maturation of corticospinal descending fibers.

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