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Randomized Controlled Trial
. 2023 Mar:43:27-35.
doi: 10.1016/j.ejpn.2023.01.013. Epub 2023 Feb 28.

Safety and feasibility of transcranial direct current stimulation stratified by corticospinal organization in children with hemiparesis

Samuel T Nemanich  1 , Daniel H Lench  2 , Ellen N Sutter  3 , Jesse L Kowalski  4 , Sunday M Francis  5 , Gregg D Meekins  6 , Linda E Krach  7 , Tim Feyma  8 , Bernadette T Gillick  9
Affiliations
Randomized Controlled Trial

Safety and feasibility of transcranial direct current stimulation stratified by corticospinal organization in children with hemiparesis

Samuel T Nemanich et al. Eur J Paediatr Neurol. 2023 Mar.

Abstract

Children with hemiparesis (CWH) due to stroke early in life face lifelong impairments in motor function. Transcranial direct current stimulation (tDCS) may be a safe and feasible adjuvant therapy to augment rehabilitation. Given the variability in outcomes following tDCS, tailored protocols of tDCS are required. We evaluated the safety, feasibility, and preliminary effects of a single session of targeted anodal tDCS based on individual corticospinal tract organization on corticospinal excitability. Fourteen CWH (age = 13.8 ± 3.63) were stratified into two corticospinal organization subgroups based on transcranial magnetic stimulation (TMS)-confirmed motor evoked potentials (MEP): ipsilesional MEP presence (MEPIL+) or absence (MEPIL-). Subgroups were randomized to real anodal or sham tDCS (1.5 mA, 20 min) applied to the ipsilesional (MEPIL + group) or contralesional (MEPIL- group) hemisphere combined with hand training. Safety was assessed with questionnaires and motor function evaluation, and corticospinal excitability was assessed at baseline and every 15 min for 1 h after tDCS. No serious adverse events occurred and anticipated minor side effects were reported and were self-limiting. Six of 14 participants had consistent ipsilesional MEPs (MEPIL + group). Paretic hand MEP amplitude increased in 5/8 participants who received real anodal tDCS to either the ipsilesional or contralesional hemisphere (+80% change). Application of tDCS based on individual corticospinal organization was safe and feasible with expected effects on excitability, indicating the potential for tailored tDCS protocols for CWH. Additional research involving expanded experimental designs is needed to confirm these effects and to determine if this approach can be translated into a clinically relevant intervention.

Keywords: Brain excitability; Hemiparesis; Motor evoked potential; Perinatal stroke; Transcranial direct current stimulation.

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Conflict of interest statement

Declaration of competing interest There are no overlapping or competing submissions associated with this manuscript. The authors have no relevant financial or other conflicts of interests to disclose.

Figures

Figure 1:
Figure 1:
Study design and experimental procedures. Baseline testing consisted of spTMS to determine CST excitability and organization pattern and safety assessment of NIBS-related symptoms. The upper limb in the figure refers to the paretic upper limb, and the gray oval indicates the ipsilesional hemisphere. The intervention consisted of combined tDCS and hand motor training and a safety assessment. The anode was placed on the motor hotspot of the hemisphere in which MEPs were elicited in the paretic upper limb, and the cathode on the contralateral forehead. Post-tDCS testing consisted of 20 spTMS trials every 15 minutes for one hour and a final safety assessment. spTMS: Single-pulse TMS, CST: corticospinal tract, MEP: Motor evoked potential, M1: Motor hotspot, SO: Supraorbital, MEPIL+/−: Presence/absence of ipsilesional MEP.
Figure 2:
Figure 2:
CST excitability in the paretic upper limb. (A) Percent difference in MEP amplitude of paretic hand (APB) muscle normalized to Baseline across all time points. Dashed thin lines and small symbols represent individual data, thick solid lines and large symbols represent group means. (B) Same as in (A) for paretic wrist (extensor digitorum) muscle.
Figure 3:
Figure 3:
CST excitability in the non-paretic upper limb for the MEPIL+ subgroup (Sham tDCS: n = 2; Real tDCS n = 4). (A) Percent difference in MEP amplitude of non-paretic hand normalized to Baseline across all time points. Dashed thin lines and small symbols represent individual data, thick solid lines and large symbols represent group means. (B) Same as in (A) for the non-paretic wrist.
Figure 4:
Figure 4:
CST excitability in the non-paretic upper limb for the MEPIL− subgroup (Sham tDCS: n = 4; Real tDCS n = 4). (A) Percent difference in MEP amplitude of non-paretic hand normalized to Baseline across all time points. Dashed thin lines and small symbols represent individual data, thick solid lines and large symbols represent group means. (B) Same as in (A) for the non-paretic wrist.
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