Safety and feasibility of transcranial direct current stimulation stratified by corticospinal organization in children with hemiparesis

Samuel T Nemanich; Daniel H Lench; Ellen N Sutter; Jesse L Kowalski; Sunday M Francis; Gregg D Meekins; Linda E Krach; Tim Feyma; Bernadette T Gillick

doi:10.1016/j.ejpn.2023.01.013

Safety and feasibility of transcranial direct current stimulation stratified by corticospinal organization in children with hemiparesis

Eur J Paediatr Neurol. 2023 Mar:43:27-35. doi: 10.1016/j.ejpn.2023.01.013. Epub 2023 Feb 28.

Authors

Samuel T Nemanich¹, Daniel H Lench², Ellen N Sutter³, Jesse L Kowalski⁴, Sunday M Francis⁵, Gregg D Meekins⁶, Linda E Krach⁷, Tim Feyma⁸, Bernadette T Gillick⁹

Affiliations

¹ Department of Occupational Therapy, Marquette University, 1700 West Wells St., Room 140, Milwaukee, WI, 53201, USA. Electronic address: sam.nemanich@marquette.edu.
² Department of Neurology, Medical University of South Carolina, 208B Rutledge Avenue, Charleston, SC, 29425, USA.
³ Department of Rehabilitation Medicine, University of Minnesota, 420 Delaware St SE, MMC 388, Minneapolis, MN, 55455, USA.
⁴ Department of Physical Medicine and Rehabilitation, Harvard Medical School, 79/96 13th Street, Charlestown, MA, United States.
⁵ Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2312 S. 6th St.Floor 2, Suite F-275, Minneapolis, MN, 55454, USA.
⁶ Department of Neurology, University of Minnesota, 420 Delaware St SE, MMC 295, Minneapolis, MN, 55455, USA.
⁷ Department of Rehabilitation Medicine, University of Minnesota, 420 Delaware St SE, MMC 388, Minneapolis, MN, 55455, USA; Rehabilitation Medicine, Gillette Children's Specialty Healthcare, 200 University Ave E, St Paul, MN, 55101, USA.
⁸ Neurology, Gillette Children's Specialty Healthcare, 200 University Ave E, St Paul, MN, 55101, USA.
⁹ Department of Rehabilitation Medicine, University of Minnesota, 420 Delaware St SE, MMC 388, Minneapolis, MN, 55455, USA; Department of Pediatrics, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI, 53705, USA.

Abstract

Children with hemiparesis (CWH) due to stroke early in life face lifelong impairments in motor function. Transcranial direct current stimulation (tDCS) may be a safe and feasible adjuvant therapy to augment rehabilitation. Given the variability in outcomes following tDCS, tailored protocols of tDCS are required. We evaluated the safety, feasibility, and preliminary effects of a single session of targeted anodal tDCS based on individual corticospinal tract organization on corticospinal excitability. Fourteen CWH (age = 13.8 ± 3.63) were stratified into two corticospinal organization subgroups based on transcranial magnetic stimulation (TMS)-confirmed motor evoked potentials (MEP): ipsilesional MEP presence (MEP_IL+) or absence (MEP_IL-). Subgroups were randomized to real anodal or sham tDCS (1.5 mA, 20 min) applied to the ipsilesional (MEP_IL + group) or contralesional (MEP_IL- group) hemisphere combined with hand training. Safety was assessed with questionnaires and motor function evaluation, and corticospinal excitability was assessed at baseline and every 15 min for 1 h after tDCS. No serious adverse events occurred and anticipated minor side effects were reported and were self-limiting. Six of 14 participants had consistent ipsilesional MEPs (MEP_IL + group). Paretic hand MEP amplitude increased in 5/8 participants who received real anodal tDCS to either the ipsilesional or contralesional hemisphere (+80% change). Application of tDCS based on individual corticospinal organization was safe and feasible with expected effects on excitability, indicating the potential for tailored tDCS protocols for CWH. Additional research involving expanded experimental designs is needed to confirm these effects and to determine if this approach can be translated into a clinically relevant intervention.

Keywords: Brain excitability; Hemiparesis; Motor evoked potential; Perinatal stroke; Transcranial direct current stimulation.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Child
Evoked Potentials, Motor / physiology
Feasibility Studies
Humans
Motor Cortex*
Stroke* / etiology
Transcranial Direct Current Stimulation* / methods
Transcranial Magnetic Stimulation / methods

Abstract

Publication types

MeSH terms

Grants and funding