Background: Perinatal stroke causes hemiparetic cerebral palsy. Brain stimulation may enhance motor function in adult stroke. We demonstrated that rTMS enhances motor learning therapy in children with perinatal stroke. Transcranial direct current stimulation (tDCS) may have similar capacity but is unstudied.
Hypothesis: tDCS increases motor function in hemiparetic children undergoing 2 weeks of motor learning therapy.
Methods: Randomized, controlled, double blind clinical trial. Subjects were recruited from a population-based cohort with MRI-classified unilateral perinatal stroke, age 6-18 years, and disabling hemiparesis. All completed a goal-directed, peer-supported, 2 week “after school” motor learning camp (32 hours of therapy). Subjects were randomized 1:1 to 1mA cathodal tDCS over the contralesional primary motor cortex 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. Analysis was intention-to-treat.
Results: Twenty-four subjects were randomized (median 11.8+/-2.7 years, range 6.7-17.8). COPM performance and satisfaction scores more than doubled at 1 week with sustained gains at 2 months (p<0.001). Both COPM scores increased more with tDCS compared to sham (p=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 under-dosing of therapy and/or modest sample size. Greater gains in subjective function with tDCS warrant further study.