Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients

Abstract

Spastic cerebral palsy (CP) is the one of most common neurological disorders occurring due to damage to the immature brain or any other brain lesion at the time of birth. To aid in making the life of the CP patient meaningful, several interventions such as medical, surgical and rehabilitation have been employed to date. Besides these, recently repetitive Transcranial magnetic stimulation (r-TMS) is a new found approach which is being employed for treating various neurological and psychological conditions. The aim of this study was to observe the effects of r-TMS on muscle spasticity in CP patients by stimulating the motor cortex area of the brain, which is responsible for muscle movements. In this study, 20 subjects diagnosed with CP were recruited and 10 each were placed in two groups, namely the research group (RG) (mean age, height and weight were 7.99 (SD = 4.66) years, 116.7 (SD = 23.57) cm and 21.40 (SD = 10.95) kg, respectively) and the control group (CG) (mean age, height and weight were 8.41 (SD = 4.32) years, 107.9 (SD = 26.33) cm, 21.40 (SD = 12.63) kg, respectively). r-TMS frequencies of 5 Hz and 10 Hz were administered for 15 min daily to patients in RG followed by standard therapy (ST) of 1 h duration daily for 20 days. Moreover, the patients in the control group (CG) were given only standard therapy (ST) of 1 h duration for 20 days. Modified Ashworth Scale (MAS) was used as an outcome measure to determine the level of muscle spasticity. A pre- assessment of MAS score was performed on both RG and CG to determine the level of spasticity prior to starting therapy; and similarly post-assessment after 20 days was done to observe the changes post-therapy. Statistical analysis of pre vs post MAS scores showed that few muscles showed reduction in muscle tightness after administering only ST in the CG. On the contrary, the RG that underwent r-TMS therapy combined with ST showed a significant decrease (p < 0.05) in muscle tightness for all the muscles selected for the therapy.

Keywords:

• Repetitive Transcranial Magnetic Stimulation (r-TMS)
• motor cortex
• Upper Motor Neuron (UMN)
• spasticity
• muscle tone

Acknowledgements

This work is supported by funding received (Ref: SEED/TIDE/007/2013) from the Technology Intervention for Disabled and Elderly (TIDE) of the Department of Science and Technology (DST), Government of India, New Delhi to North Eastern Hill University Shillong, Meghalaya, 793022, India. The authors also acknowledge the support of all the therapists and staff of UDAAN-for the disabled, Delhi and HCRA for assisting in patient selection. A special thanks to all participating spastic cerebral palsy patients and their parents.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.