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

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 ۴ to ۱۳ years. Six children received ۱۲ sessions of LF-rTMS, while four in the control group underwent ۱۲ 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 (iS۱) (for effect size: T=-۲.۶۰, P-value=۰.۰۴۸, FDR-corrected) and the ipsilesional primary motor area (iM۱) (T=-۲.۴۵, P-value=۰.۰۴۸, 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 (S۲) (T=-۳.۱۱, P-value=۰.۰۴۱, FDR-corrected).  Conclusion: LF-rTMS may modulate FC and hold promise as a rehabilitative intervention for improving motor function in children with HCP.

کلیدواژه ها:

cerebral palsy ، Transcranial Magnetic Stimulation ، Functional Connectivity ، Magnetic Resonance Imaging