Repetitive Transcranial Magnetic Stimulation on Motor Function and Meta-Plasticity in Cerebral Palsy: TMS-EEG Study

Cerebral Palsy (CP) is a neurodevelopmental condition marked by motor impairments that affect both upper and lower limbs. This project investigates the therapeutic benefits, safety, and tolerability of repetitive transcranial magnetic stimulation (rTMS) for improving motor function and meta-plasticity (re-organization) in children with CP. Specifically, the study investigates the effects of 6-Hz primed low and high-frequency rTMS on neural motor function and meta-plasticity, utilizing TMS-EEG as a core method for assessing motor evoked potentials (MEPs) and TMS-evoked potentials (TEPs). Through modulating cortical excitability, the investigators expect that 6-Hz primed low and high-frequency rTMS will improve motor function and generate meta-plasticity in children with CP. This improvement in motor and induced meta-plasticity potentially leads to faster rehabilitation outcomes and reduced need for long-term care, which would benefit both patients and hospital systems by lowering treatment costs and improving resource allocation.

Inclusion criteria

(CP):

• Aged 6 - 20 years,
• A confirmed diagnosis of CP by a specialized professional (pediatric neurologist, PM&R physician, neonatal developmental specialist, or neonatologist) is a prerequisite for participation,
• Classified as high functioning (Level I, II, or III) according to the Gross Motor Function Classification System (GMFCS),
• Age-appropriate ability to understand and comply with study procedure throughout the entire duration of the study,
• Preserved vision and hearing (with or without correction).

Inclusion criteria

(TD):

• Aged 6 - 20 years
• Age-appropriate ability to understand and comply with study procedure throughout the entire duration of the study,
• Preserved vision and hearing (with or without correction).

Exclusion criteria

(CP):

• Syndromic or genetic brain-related associations,
• History of major trauma or brain surgery,
• Inability to remain still,
• History of Epilepsy,
• Severe coexisting sickness or illness unrelated to CP or unstable medical conditions such as pneumonia,
• Modified Ashworth Scale: Shoulder, elbow, and wrist scores more than 3,
• Limb contractures caused by any other injury except CP,
• Severe movement disorders that prevent intentional limb movements, such as choreoathetosis, or ballismus,
• Contraindications for rTMS include non-removable metallic objects close to a coil and implanted electronic devices, such as cochlear implants and pacemakers.

Exclusion criteria

(TD):

• Syndromic or genetic brain-related associations,
• History of major trauma or brain surgery,
• Inability to remain still,
• History of Epilepsy,
• Severe coexisting sickness or illness unrelated to CP or unstable medical conditions such as pneumonia,
• Limb contractures caused by injury,
• Severe movement disorders that prevent intentional limb movements, such as choreoathetosis, or ballismus,
• Contraindications for rTMS include non-removable metallic objects close to a coil and implanted electronic devices, such as cochlear implants and pacemakers.