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Restoring Functional Connectivity in Hemiplegic Cerebral Palsy: A Study of Low-Frequency rTMS Intervention

Document Type : Original Research

Authors

1 Department of Medical Physics & Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

2 Research Center for Biomedical Technologies and Robotics (RCBTR), Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran, University of Medical Science (TUMS), Tehran, Iran

3 Laboratory of Biological Psychology, Department of Brain and Cognition, Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven 3714, Belgium

4 Department of Basic Science, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

5 Neural Engineering and Rehabilitation Research Center, Tehran, Iran

6 Department of Physical Medicine and Rehabilitation, Northwestern University, USA

10.31661/jbpe.v0i0.2410-1840

Abstract

Background: Hemiplegic Cerebral Palsy (HCP) causes significant motor impairments, due to disrupted Functional Connectivity (FC) between brain regions. Low-Frequency Repetitive Transcranial Magnetic Stimulation (LF-rTMS) has emerged as a potential therapeutic technique for restoring FC and motor recovery.
Objective: This study aimed to evaluate the effects of LF-rTMS on FC in children with spastic HCP.
Material and Methods: This Randomized Controlled Trial (RCT) included ten children with spastic HCP, aged 4 to 13 years. Six children received 12 sessions of LF-rTMS, while four in the control group underwent 12 sessions of sham stimulation. Functional Magnetic Resonance Imaging (fMRI) was used to assess intra- and interhemispheric FC during passive knee movements of the affected limb.
Results: LF-rTMS induced region-specific reductions in interhemispheric FC, particularly between the contralesional ventral premotor area (cPMv) and both the ipsilesional primary somatosensory cortex (iS1) (for effect size: T=-2.60, P-value=0.048, FDR-corrected) and the ipsilesional primary motor area (iM1) (T=-2.45, P-value=0.048, FDR-corrected). These findings suggest modulation of interhemispheric motor-sensory pathways. Concurrently, localized increases in FC were observed in contralesional regions, and FC decreased between the ipsilesional Supplementary Motor Area (SMA) and the secondary somatosensory cortex (S2) (T=-3.11, P-value=0.041, FDR-corrected). 
Conclusion: LF-rTMS may modulate FC and hold promise as a rehabilitative intervention for improving motor function in children with HCP.

Highlights

Azadeh Ghalyanchi-Langeroudi (PubMed)

Mohammad-Mehdi Mirbagheri (Google Scholar)

Keywords

References
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Journal of Biomedical Physics and Engineering
Volume 15, Issue 2 - Serial Number 1
70
April 2025
Pages 173-184
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