Increasing Number of Therapy Sessions of Repetitive Transcranial Magnetic Stimulation Improves Motor Development by Reducing Muscle Spasticity in Cerebral Palsy Children

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

Abstract

Background: Repetitive TMS (rTMS), a non-invasive neuro-stimulation tool based on the principle of electromagnetic induction is recently being employed both for investigational and interventional purposes. The stimulating effect of rTMS on motor cortex areas of the brain leads to increased motor activity and decreased muscle tone in spastic cerebral palsy (CP) patients.

Objective: This modulatory effect of rTMS is used in this study to evaluate its effect on motor function and spasticity by increasing the number of therapy session and keeping frequency of 10Hz and pulse train of 2500 constant.

Methods: Total thirty spastic CP patients participated in this study after written informed consent from their parents/guardians. The participants were equally divided into three groups, namely, S-20, S-30 and S-40 depending on the number of therapy sessions. The mean age±SD of participants in different groups were 8.9±3.6, 9.5±2.9 and 8.4±3.5 in S-20, S-30 and S-40 respectively. Participants in S-20, S-30 and S-40 were provided 20, 30 and 40 sessions of rTMS therapy respectively followed by physical therapy of 30 minutes daily. Each rTMS session was of 25 minutes duration and was administered once daily for 5 days a week. Prior to start and after completion of the therapy, pre and post assessment of gross motor function measure (GMFM) for motor function and modified Ashworth scale (MAS) for muscle spasticity was performed on all the participants.

Outcomes: The result of pre-versus-post GMFM score showed that 4.27%, 3.12% and 2.36% motor gain was obtained after 40, 30 and 20 sessions of therapy respectively. In addition, significant reduction in spasticity in both upper and limb muscles was also observed in all the three groups.

Keywords: Cerebral palsy; Modified Ashworth Scale; gross motor function measure; spasticity; transcranial magnetic stimulation.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Box-plot showing change in median values of gross motor function measure scores of different groups obtained from a range of functional values
Figure 2
Figure 2
Gross motor function measure scores of different groups obtained from a range of functional values
Figure 3
Figure 3
Increased motor gain due to increased repetitive TMS sessions
Figure 4
Figure 4
Reduction in spasticity of lower limb muscles observed in different groups
Figure 5
Figure 5
Reduction in spasticity of upper limb muscles observed in different groups

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Source: PubMed

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