TITLE:
Therapeutic Application of High-Frequency rTMS Combined with Intensive Occupational Therapy for Pediatric Stroke Patients with Upper Limb Hemiparesis: A Case Series Study
AUTHORS:
Masachika Niimi, Wataru Kakuda, Toru Takekawa, Ryo Momosaki, Takatoshi Hara, Hiroshi Ito, Yumi Kameda, Masahiro Abo
KEYWORDS:
Pediatric Stroke; Repetitive Transcranial Magnetic Stimulation; Occupational Therapy; Upper Limb Hemiparesis; Motor Recovery
JOURNAL NAME:
Journal of Behavioral and Brain Science,
Vol.3 No.2,
May
23,
2013
ABSTRACT: Low-frequency repetitive transcranial magnetic
stimulation (LF-rTMS) applied to the non-lesional hemisphere is reported
to significantly improve motor function of the affected upper limb in adult
stroke patients with hemiparesis. For pediatric stroke patients, the beneficial
effects of LF-rTMS have been already confirmed in a randomized controlled
study. However, there is no report of therapeutic application of high-frequency
rTMS (HF-rTMS) in this patient population. In this case series study, we introduced
HF-rTMS combined with intensive occupational therapy (OT) in two pediatric
hemiparetic patients. We studied two children (8- and 9-year-old boys, both
right-handed) with post-stroke upper limb hemiparesis (chronic phase). Both
patients underwent 22 treatment sessions of HF-rTMS/OT during 15-day hospitalization.
The HF-rTMS was applied over the lesional motor cortex at a frequency of 10Hz
for 15 minutes in each session. One session of intensive OT consisted of 30-min
one-to-one training and 30-min self-exercise. Motor function of the affected
upper limb was serially evaluated with Fugl-Meyer Assessment (FMA), Wolf Motor
Function Test (WMFT), Simple Test for Evaluating hand Function (STEF), and
Ten-second Test. Neither of the patients showed any adverse effects. Both patients
showed improvement of motor function in the affected upper limb and were able
to use the affected upper limb in some activities of daily living. In the two
post-stroke pediatric patients, HF-rTMS/OT was safe and improved upper limb
muscle function. Confirmation of these effects in a larger population is
needed.