Transcranial Direct Current Stimulation (tDCS) in Unilateral Cerebral Palsy: A Pilot Study of Motor Effect

Emanuela Inguaggiato, Nadia Bolognini, Simona Fiori, Giovanni Cioni, Emanuela Inguaggiato, Nadia Bolognini, Simona Fiori, Giovanni Cioni

Abstract

Transcranial Direct Current Stimulation (tDCS) is an emerging tool to improve upper limb motor functions after stroke acquired in adulthood; however, there is a paucity of reports on its efficacy for upper limb motor rehabilitation in congenital or early-acquired stroke. In this pilot study we have explored, for the first time, the immediate effects, and their short-term persistence, of a single application of anodal tDCS on chronic upper limb motor disorders in children and young individuals with Unilateral Cerebral Palsy (UCP). To this aim, in a crossover sham-controlled study, eight subjects aged 10-28 years with UCP underwent two sessions of active and sham tDCS. Anodal tDCS (1.5 mA, 20 min) was delivered over the primary motor cortex (M1) of the ipsilesional hemisphere. Results showed, only following the active stimulation, an immediate improvement in unimanual gross motor dexterity of hemiplegic, but not of nonhemiplegic, hand in Box and Block test (BBT). Such improvement remained stable for at least 90 minutes. Performance of both hands in Hand Grip Strength test was not modified by anodal tDCS. Improvement in BBT was unrelated to participants' age or lesion size, as revealed by MRI data analysis. No serious adverse effects occurred after tDCS; some mild and transient side effects (e.g., headache, tingling, and itchiness) were reported in a limited number of cases. This study provides an innovative contribution to scientific literature on the efficacy and safety of anodal tDCS in UCP. This trial is registered with NCT03137940.

Figures

Figure 1
Figure 1
CONSORT diagram and study flow.
Figure 2
Figure 2
BBT scores (i.e., number of blocks moved in 1 min) for the hemiplegic and nonhemiplegic hands, at each assessment of the active anodal tDCS and sham tDCS sessions. T0 = baseline; T1 = immediately after the end of tDCS; T2 = 90 min after the stimulation session. ∗ = significant change from baseline, p < 0.05.
Figure 3
Figure 3
HGS scores (i.e., mean voluntary isometric strength, in kg) for the hemiplegic and nonhemiplegic hands, at each assessment of the real anodal tDCS and sham tDCS sessions. T0 = baseline; T1 = immediately after the end of tDCS; T2 = 90 min after the stimulation session.

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