Neuromodulation induced by non-invasive transcranial stimulation in hemiplegia
(2007) Participation and quality of life of children with cerebral palsy across Europe A F T COLVER MA MD FRCPCH — Location: Newcastle University, Newcastle-upon-Tyne, UK
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- Motor performance of hemiplegic patients can be transiently enhanced when cortical excitability is ccurately modulated by transcranial stimulation. Besides a non-specific boosting of cortical activity, such neuromodulatory interventions may actually release latent neuronal plasticity. Potential applications in paediatric patients could be extrapolated based on adult stroke patient’s studies. Recently, repetitive transcranial magnetic stimulation (rTMS)and transcranial direct current stimulation (tDCS) – two noninvasive neuromodulatory interventions – have been used successfully to improve motor performance in adult hemiplegic stroke patients. On the one hand, the cortical excitability of the stroke hemisphere can be up-regulated by high-frequency (≥5Hz) rTMS or anodal tDCS; this results in a motor function improvement. On the other hand, down-regulating the intact hemisphere with low-frequency (≤1Hz) rTMS or cathodal tDCS can improve motor and cognitive functions in those hemiplegic patients in whom an unbalanced interhemispheric inhibitory drive acts as a brake on the functioning of the stroke hemisphere. Ultimately, the priming of neuronal plasticity through transcranial stimulation could result in long-term functional recovery when applying these neuromodulatory interventions over cumulative sessions in combination with rehabilitative training. Since the potential for effective neuronal plasticity declines as maturation progresses, paediatric patients could theoretically benefit more than adult patients from neuromodulatory approaches. Conversely, potential adverse effects should be carefully pondered before applying transcranial stimulation to developing central nervous systems. So far, tDCS has not been used in paediatric patients whereas rTMS has been applied in less than 40 paediatric patients suffering from attention-deficit–hyperactivity disorder, depression, or intractable epilepsy.
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Vandermeeren, Y. (2007). Neuromodulation induced by non-invasive transcranial stimulation in hemiplegia. Participation and quality of life of children with cerebral palsy across Europe A F T COLVER MA MD FRCPCH, Newcastle University, Newcastle-upon-Tyne, UK. https://hdl.handle.net/2078.5/225167