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Effects of rTMS on Ipsilateral Corticomotor Projections in Children with Perinatal Stroke:

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.

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Effects of rTMS on Ipsilateral Corticomotor Projections in Children with Perinatal Stroke:

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  1. 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, KirtonA

  2. Disclosures • No conflicts • Non-invasive brain stimulation is experimental in kids

  3. 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

  4. Perinatal Stroke Perinatal Stroke = Motor System Injury = Hemiparetic CP Arterial Presumed Perinatal Ischemic Stroke (APPIS) Periventricular Venous Infarction (PVI) Symptomatic Neonatal AIS (NAIS)

  5. PVI AIS-MCA Ipsilateral Projections > 0.05mV at 120% RMT in >5/20 trials

  6. Aims • Determine the neurophysiology of ipsilateral connections in perinatal stroke • Hypothesis: The unlesioned hemisphere controls both contra- and ipsi-lateral physiology • Investigate the effects of inhibitory rTMSon ipsilateral projections in perinatal stroke • Hypothesis: rTMS inhibits ipsilateral corticomotor projections

  7. TMS Neurophysiology Faraday's Law of Magnetic Induction • 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)

  8. www.clinicaltrials.govNCT01189058 PLASTIC CHAMPS Brain Camp rTMS: 1Hz x 20 minutes OR sham CIMT: Cast x 90% waking hours

  9. Results • Interim analysis of 35 children • Mean age 11.25years, 20 male • 55% arterial, 45% PVI • 15rTMS versus 20sham N = 18 excluded N = 35 N = 17 Met ipsi criteria

  10. 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). • IpsiSRC 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)

  11. Results Non-lesionalrTMS affected contralateral as expected: Increased RMT and lowered SRC slope

  12. Results Non-lesionalrTMS had less effect on ipsilateral physiology: • No change in ICF Trends to lower SRC slope and increased SICI Ipsilateral SRC Slope Ipsilateral SICI

  13. Results Children with ipsilateral projections did not show a decrease in motor function with rTMS MA improved, AHA unchanged

  14. Results Changes cortical physiology correlated between contralateral and ipsilateral sides SICI ICF

  15. 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

  16. Acknowledgements Dr. AleksMineyko TarynBemister Jessica Denys Jacquie Hodge Jenny Saunders Jamie Roe Helen Carlson SiddharthShinde Dave Czank PLASTIC CHAMPS 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 • APSP Stollery Edmonton • Dr. Jerome Yager • APSP Glenrose Edmonton • Dr. John Andersen • Kathleen O’Grady TMS ACH Pediatric TMS Laboratory Oleg Kotsovsky Omar Damji Dr. ThilinieRajapakse Toronto Western Research Institute Dr. Robert Chen Carolyn Gunraj • SickKids Stroke Program • Dr. Gabrielle deVeber • Neuroimaging • Dr. Xing-Chang Wei • Dr. Jayme Kosior • Clinical Research Unit • Christina Ma

  17. www.perinatalstroke.ca

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