SICI ICF

Report
Effects of rTMS on Ipsilateral Corticomotor Projections in Children
with Perinatal Stroke:
Neuromodulation feasibility in the PLASTIC CHAMPS trial
Damji O, Kotsovsky O, Chen R, Kirton A
Disclosures
• No conflicts
• Non-invasive brain stimulation is experimental in kids
Stroke Can Happen in Kids?
• Common
– >1:2500 live births =
>1000 Alberta children.
– #1 cause hemiplegic CP
• Poorly understood
• Poor outcomes
•
No prevention or treatment
• Ideal model for studying
neuroplasticity in children
Perinatal Stroke
Perinatal Stroke = Motor System Injury = Hemiparetic CP
Symptomatic
Neonatal AIS
(NAIS)
Arterial Presumed
Perinatal Ischemic
Stroke
(APPIS)
Periventricular
Venous Infarction
(PVI)
PVI
Ipsilateral
Projections
> 0.05mV at
120% RMT in
>5/20 trials
AIS-MCA
Aims
• Determine the neurophysiology of ipsilateral
connections in perinatal stroke
– Hypothesis: The unlesioned hemisphere controls both contraand ipsi-lateral physiology
• Investigate the effects of inhibitory rTMS on ipsilateral
projections in perinatal stroke
– Hypothesis: rTMS inhibits ipsilateral corticomotor projections
Faraday's Law of Magnetic Induction
TMS Neurophysiology
•
Rest Motor Threshold (RMT)
•
Stimulus Response Curve (SRC)
– 100 / 110 / 120 / 130 / 140 / 150%
•
Paired-Pulse Methods
– Short Interval Intracortical Inhibition (SICI)
– Intracortical Facilitation (ICF)
www.clinicaltrials.govNCT01189058
PLASTIC CHAMPS trial
Plastic Adapatation Stimulated by TMS and Induced Constraint
for
Congenital Hemiplegia After Motor Perinatal Stroke
PLASTIC CHAMPS Brain Camp
rTMS: 1Hz x 20 minutes OR sham
CIMT: Cast x 90% waking hours
Results
•
•
•
•
Interim analysis of 35 children
Mean age 11.25 years, 20 male
55% arterial, 45% PVI
15 rTMS versus 20 sham
N = 18
excluded
N = 35
N = 17
Met ipsi
criteria
Results – Ipsilateral Projections
•
17 (49%) of children had ipsilateral projections
•
Presence and intensity correlated with disability
– AHA (r=-0.58; p=0.004) and MA (r=-0.45; p=0.013).
•
Ipsi SRC slope was lower than contra (p=0.01).
•
SICI was present bilaterally
– contra -38.5%, ipsi -30.7%
•
ICF was present bilaterally
– contra +15.4%, ipsi +23.1%
•
SICI and ICF differed between sides (p= 0.004)
Results
Non-lesional rTMS affected contralateral as expected:
Increased RMT and lowered SRC slope
Results
Non-lesional rTMS had less effect on ipsilateral physiology:
No change in ICF
Trends to lower SRC slope and increased SICI
Ipsilateral SRC Slope
Ipsilateral SICI
Results
Children with ipsilateral projections did not show a
decrease in motor function with rTMS
MA improved, AHA unchanged
Results
Changes cortical physiology correlated between contralateral and ipsilateral sides
SICI
ICF
Conclusions
• Contralesional inhibitory rTMS is feasible in kids with
perinatal stroke and ipsilateral projections
• rTMS effects on corticomotor neurophysiology are more
predictable on the contralateral side
• rTMS shifts in corticomotor neurophysiology correlate
between contra and ipsi-lateral systems
Acknowledgements
PLASTIC CHAMPS
APSP Stollery Edmonton
Dr. Jerome Yager
APSP Glenrose Edmonton
Dr. John Andersen
Kathleen O’Grady
SickKids Stroke Program
Dr. Gabrielle deVeber
Neuroimaging
Dr. Xing-Chang Wei
Dr. Jayme Kosior
Clinical Research Unit
Christina Ma
TMS
Dr. Aleks Mineyko
Taryn Bemister
Jessica Denys
Jacquie Hodge
Jenny Saunders
Jamie Roe
Helen Carlson
Siddharth Shinde
Dave Czank
ACH Pediatric TMS Laboratory
Oleg Kotsovsky
Omar Damji
Dr. Thilinie Rajapakse
Toronto Western Research Institute
Dr. Robert Chen
Carolyn Gunraj
Calgary Stroke Program
Dr. Michael Hill
Dr. Sean Dukelow
ACH RMT
Dr. Alberto Nettel-Aguirre
Dr. Brent Hagel
ACH CIMT Program / Rehab
Tamara Thicke
Gillian Hoyt-Hallett
Clare O’Byrne
Colleen Lane, Mia Herrero
www.perinatalstroke.ca

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