神経学的障害

Effect of Repetitive Transcranial Magnetic Stimulation on Hand Function of Spastic Cerebral Palsy Children

Abstract

Bablu Lal Rajak, Meena Gupta, Dinesh Bhatia and Arun Mukherjee

Repetitive Transcranial magnetic stimulation (rTMS) is emerging as a new investigation as well as treatment tool for various neurological and psychiatric diseases. Recent studies showed its application as treatment tool in movement disorders, where rTMS stimulation on primary motor cortex alters physiological patterns of motor threshold; motor evoked potential and cortical plasticity which induces motor activity. Recent studies on rTMS combined with rehabilitation therapy demonstrated functional improvement in motor activities of spastic cerebral palsy (sCP) children. Thus, this study was designed to evaluate the effect of rTMS on hand function of sCP patients.

Forty-five children diagnosed as sCP participated in this study after written consent from their parents or guardians. They were divided into three groups- control (CG) and interventional group (IG-A and IG-B). Participants in CG were provided only physical therapy (PT) of 30 minutes duration daily for 20 days and those in IG were administered rTMS frequency of 5Hz (IG-A) and 10Hz (IG-B) for 15 minutes consisting of 1500 pulses daily for 20 days; followed by PT as given to CG. Quality of upper extremity skill test (QUEST) scoring was used for evaluating the improvement in hand function of sCP patients. The pre (before starting any therapy) versus post (after completion of 20 sessions) mean QUEST score between different groups were statistically significant (p<0.01) and the mean change was 0.61, 2.46 and 2.87 in CG, IG-A and IG-B respectively.

However, encouraging functional improvement in hand function was observed in diplegic patients in the age group of 2-6 years employing 5Hz frequency and higher frequency (10Hz) induced better activity in hemiplegic and quadriplegic patient of older age groups (7-16 years).