Cerebral Palsy, Typically Developing Children
Conditions
Keywords
Cerebral Palsy, CP, TMS, repetitive Transcranial Magnetic Stimulation, Transcranial Magnetic Stimulation, rTMS, TMS-EEG
Brief summary
This project examines the use of repetitive transcranial magnetic stimulation (rTMS) as a therapeutic approach to improve motor function in children with cerebral palsy (CP). By applying 6-Hz primed low and high-frequency rTMS and measuring brain responses through TMS-EEG, the study aims to enhance neural plasticity and motor recovery. The goal is to promote faster rehabilitation and reduce long-term healthcare needs.
Detailed description
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.
Interventions
DEVICEMRI
All participants will undergo an MRI scan prior to the intervention to acquire T1-weighted images. MRI data will be provided by the Cook Children's Radiology Department. MRI scans will be used for neuronavigation.
DEVICEHD-EEG Recording
High-density EEG (HD-EEG) is a safe and non-invasive brain imaging technique. It involves placing a cap with small sensors on the child's head to measure the brain's electrical activity. This technique does not send any energy into the brain. The investigators will use the HD-EEG to measure motor-evoked potentials (MEPs) and TMS-evoked potentials (TEPs).
DEVICErTMS
rTMS is a safe, non-invasive way to map brain activity using gentle magnetic pulses. A small coil is placed near the head to stimulate nerve cells without any pain. This helps us understand how the brain controls movement.
Sponsors
Cook Children's Health Care System
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
6 Years to 20 Years
Healthy volunteers
Yes
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change on TMS-evoked potentials (TEPs) | Within the end of 4 weeks and 1-month follow-up of sham/real rTMS | TEPs refer to the electrical responses in the brain elicited by rTMS. This technique involves applying magnetic pulses to specific brain areas, which induce electrical activity that can be recorded using EEG. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change on cortical excitability - motor evoked potentials (MEPs) | Within the end of 4 weeks and 1-month follow-up of sham/real rTMS | MEPs are electrical signals generated by stimulating the brain's motor cortex and recorded from muscles. |
Countries
United States
Contacts
CONTACTChristos Papadelis, PhD
CONTACTBehnam Ghabel Damirchi, MSc
PRINCIPAL_INVESTIGATORChristos Papadelis, PhD
Cook Children's Health Care System
Outcome results
None listed