Transcranial direct current stimulation for children with perinatal stroke and hemiparesis
Transcranial direct current stimulation for children with perinatal stroke and hemiparesis
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DOI：
10.1212/wnl.0000000000003518
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发表时间：
2017-01-17
期刊：
影响因子：
9.9
通讯作者：
Hill, Michael
中科院分区：
文献类型：
--
作者：
Kirton, Adam;Ciechanski, Patrick;Hill, Michael
目的：为了确定是否经颅直流电刺激（tDCS）的强化治疗增加运动功能的围产期中风和偏瘫型脑瘫。方法：这是一个随机，对照，双盲临床试验。参与者是从一个基于人群的队列中招募的，MRI分类为单侧围产期卒中，年龄6至18岁，致残性轻偏瘫。所有人都完成了一个目标导向，同伴支持，为期2周的课后运动学习营（32小时的治疗）。在每日治疗或假手术的最初20分钟内，将参与者以1：1的比例随机分配至对侧原发性运动皮层（M1）上的1 mA阴极tDCS。在干预后1周和2个月测量主要主观（加拿大职业表现量表[COPM]）、客观（辅助手评估[AHA]）、安全性和次要结局。结果：24名参与者被随机分组（中位年龄11.8 6 +/- 2.7岁，范围6.7-17.8）。COPM表现和满意度评分在1周时翻了一番，在2个月时持续增加（p，0.001）。与假手术对照组相比，tDCS组COPM评分增加更多（p <5 <0.004）。在两个时间点，AHA评分仅轻度增加，无tDCS效应。程序是安全的，耐受性良好，没有减少任何手臂功能或严重的不良事件。结论：tDCS试验出现偏瘫儿童的可行性和安全性。客观运动功能缺乏变化可能反映了治疗剂量不足。tDCS的主观功能显著改善值得进一步研究。
Objective: To determine whether the addition of transcranial direct current stimulation (tDCS) to intensive therapy increases motor function in children with perinatal stroke and hemiparetic cerebral palsy.Methods: This was a randomized, controlled, double-blind clinical trial. Participants were recruited from a population-based cohort with MRI-classified unilateral perinatal stroke, age of 6 to 18 years, and disabling hemiparesis. All completed a goal-directed, peer-supported, 2-week after-school motor learning camp (32 hours of therapy). Participants were randomized 1: 1 to 1 mA cathodal tDCS over the contralesional primary motor cortex (M1) for the initial 20 minutes of daily therapy or sham. Primary subjective (Canadian Occupational Performance Measure [COPM]), objective (Assisting Hand Assessment [AHA]), safety, and secondary outcomes were measured at 1 week and 2 months after intervention. Analysis was by intention to treat.Results: Twenty-four participants were randomized (median age 11.8 6 +/- 2.7 years, range 6.7-17.8). COPM performance and satisfaction scores doubled at 1 week with sustained gains at 2 months (p, 0.001). COPM scores increased more with tDCS compared to sham control (p 5 0.004). AHA scores demonstrated only mild increases at both time points with no tDCS effects. Procedures were safe and well tolerated with no decrease in either arm function or serious adverse events.Conclusion: tDCS trials appear feasible and safe in hemiparetic children. Lack of change in objective motor function may reflect underdosing of therapy. Marked gains in subjective function with tDCS warrant further study.