The use of transcranial direct current stimulation in individuals with cerebral palsy: a scoping review
DOI:
https://doi.org/10.17267/2965-3738bis.2023.e5006Keywords:
Cerebral palsy, Transcranial direct current stimulation, Evidence-based medicine, ReviewAbstract
BACKGROUND: Cerebral palsy (CP) is a neurodevelopmental condition that begins in early childhood and persists throughout life, causing limitations in daily activities and social participation. Neuromodulatory interventions using non-invasive brain stimulation, like transcranial direct current stimulation (tDCS), have been increasingly investigated, aiming to influence cortical excitability in neurologic conditions, including CP. OBJECTIVE: To summarize current evidence for the use of tDCS on individuals with CP. METHODS: Using scoping review methodology, the terms "cerebral palsy" and "transcranial direct current stimulation" were screened in PubMed, Cochrane, LILACS, SciELO, PEDro, and Embase databases, searching for clinical trials that applied tDCS interventions into children and adults with CP. Quality assessment of all eligible studies was performed using the PEDro Scale. RESULTS: A total of 1773 articles (including duplicates) were found, of which 14 met the predetermined criteria. Two hundred and thirty-three individuals with CP, with ages ranging from 5 to 27 years, participated in these studies. The main therapeutic effects of anodal tDCS were reported on upper limb dysfunctions, balance, and gait. The primary motor cortex was the most frequently applied target. The combined use of tDCS with other motor training techniques, such as constraint-induced movement therapy (CIMT) and treadmill locomotor training, showed better results. CONCLUSION: Emerging evidence reveals that the use of tDCS in individuals with CP is safe, feasible, easy to apply, tolerable, and effective when performed according to the recommendations available to date. The tDCS protocols in these studies were partially homogeneous, and sample sizes were generally small. More large-scale longitudinal studies are needed, particularly in individuals with ataxic and dyskinetic CP.
References
(1) Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005;47(8):571-6. http://dx.doi.org/10.1017/s001216220500112x
(2) Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8-14. Cited: PMID: 17370477
(3) Michael-Asalu A, Taylor G, Campbell H, Lelea LL, Kirby RS. Cerebral Palsy: Diagnosis, Epidemiology, Genetics, and Clinical Update. Adv Pediatr. 2019;66:189-208. https://doi.org/10.1016/j.yapd.2019.04.002
(4) Rethlefsen SA, Ryan DD, Kay RM. Classification systems in cerebral palsy. Orthop Clin North Am. 2010;41(4):457-67. https://doi.org/10.1016/j.ocl.2010.06.005
(5) Cerebral Palsy Alliance Research Institute. Report of the Australian Cerebral Palsy Register, Birth Years 1993-2009 [Internet]. 2016. Available from: https://cpregister.com/wp-content/uploads/2018/05/ACPR-Report_Web_2016.pdf
(6) Rosenbaum P, Gorter JW. The “F-words” in childhood disability: I swear this is how we should think!. Child Care Health Dev. 2012;38(4):457-63. https://doi.org/10.1111/j.1365-2214.2011.01338.x
(7) Morya E, Monte-Silva K, Bikson M, Esmaeilpour Z, Biazoli CE Jr, Fonseca A, et al. Beyond the target area: an integrative view of tDCS-induced motor cortex modulation in patients and athletes. J Neuroeng Rehabil. 2019;16:141. https://doi.org/10.1186/s12984-019-0581-1
(8) Krishnan C, Santos L, Peterson MD, Ehinger M. Safety of noninvasive brain stimulation in children and adolescents. Brain Stimul. 2015;8(1):76-87. https://doi.org/10.1016/j.brs.2014.10.012
(9) Cosmo C, Baptista AF, Araújo AN, Rosário RS, Miranda JGV, Montoya P, et al. A Randomized, Double-Blind, Sham-Controlled Trial of Transcranial Direct Current Stimulation in Attention-Deficit/Hyperactivity Disorder. PLoS One. 2015;10(8):e0135371. https://doi.org/10.1371/journal.pone.0135371
(10) Hamilton A, Wakely L, Marquez J. Transcranial Direct-Current Stimulation on Motor Function in Pediatric Cerebral Palsy: A Systematic Review. Pediatr Phys Ther. 2018;30(4):291-301. https://doi.org/10.1097/pep.0000000000000535
(11) Fleming MK, Theologis T, Buckingham R, Johansen-Berg H. Transcranial direct current stimulation for promoting motor function in cerebral palsy: a review. J Neuroeng Rehabil. 2018;15:121. https://doi.org/10.1186/s12984-018-0476-6
(12) Santos LV, Lopes JBP, Duarte NAC, Castro CRAP, Grecco LAC, Oliveira CS. tDCS and motor training in individuals with central nervous system disease: A systematic review. J Bodyw Mov Ther. 2020;24(4):442-51. https://doi.org/10.1016/j.jbmt.2020.07.010
(13) Antal A, Alekseichuk I, Bikson M, Brockmöller J, Brunoni AR, Chen R, et al. Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines. Clin Neurophysiol. 2017;128(9):1774-809. https://doi.org/10.1016/j.clinph.2017.06.001
(14) Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, et al. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep. 2020;20:3. https://doi.org/10.1007/s11910-020-1022-z
(15) Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. https://doi.org/10.1080/1364557032000119616
(16) Daudt HML, van Mossel C, Scott SJ. Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC Med Red Methodol. 2013;13:48. http://dx.doi.org/10.1186/1471-2288-13-48
(17) Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. https://doi.org/10.1186/1748-5908-5-69
(18) Colquhoun HL, Levac D, O’Brien KK, Straus S, Tricco AC, Perrier L, et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67(12):1291-4. https://doi.org/10.1016/j.jclinepi.2014.03.013
(19) Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med. 2009;151(4):264-9. http://dx.doi.org/10.7326/0003-4819-151-4-200908180-00135
(20) Moseley AM, Herbert RD, Sherrington C, Maher CG. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Aust J Physiother. 2002;48(1):43-9. https://doi.org/10.1016/s0004-9514(14)60281-6
(21) Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713-21. Cited: PMID: 12882612
(22) Grecco LAC, Duarte NAC, Zanon N, Galli M, Fregni F, Oliveira CS. Effect of a single session of transcranial direct-current stimulation on balance and spatiotemporal gait variables in children with cerebral palsy: A randomized sham-controlled study. Braz J Phys Ther. 2014;18(5):419-27. https://doi.org/10.1590/bjpt-rbf.2014.0053
(23) Grecco LAC, Duarte NAC, Mendonça ME, Galli M, Fregni F, Oliveira CS. Effects of anodal transcranial direct current stimulation combined with virtual reality for improving gait in children with spastic diparetic cerebral palsy: a pilot, randomized, controlled, double-blind, clinical trial. Clin Rehabil. 2015;29(12):1212-23. https://doi.org/10.1177/0269215514566997
(24) Duarte NAC, Grecco LAC, Galli M, Fregni F, Oliveira CS. Effect of transcranial direct-current stimulation combined with treadmill training on balance and functional performance in children with cerebral palsy: a double-blind randomized controlled trial. PLoS One. 2014;9(8):e105777. https://doi.org/10.1371/journal.pone.0105777
(25) Grecco LAC, Duarte NAC, Mendonça ME, Cimolin V, Galli M, Fregni F, et al. Transcranial direct current stimulation during treadmill training in children with cerebral palsy: a randomized controlled double-blind clinical trial. Res Dev Disabil. 2014;35(11):2840-8. https://doi.org/10.1016/j.ridd.2014.07.030
(26) Lazzari RD, Politti F, Belina SF, Grecco LAC, Santos CA, Dumont AJL, et al. Effect of Transcranial Direct Current Stimulation Combined With Virtual Reality Training on Balance in Children With Cerebral Palsy: A Randomized, Controlled, Double-Blind, Clinical Trial. J Mot Behav. 2017;49(3):329-36. https://doi.org/10.1080/00222895.2016.1204266
(27) Kirton A, Ciechanski P, Zewdie E, Andersen J, Nettel-Aguirre A, Carlson H, et al. Transcranial direct current stimulation for children with perinatal stroke and hemiparesis. Neurology. 2017;88(3):259-67. https://doi.org/10.1212/wnl.0000000000003518
(28) Aree-uea B, Auvichayapat N, Janyacharoen T, Siritaratiwat W, Amatachaya A, Prasertnoo J, et al. Reduction of spasticity in cerebral palsy by anodal transcranial direct current stimulation. J Med Assoc Thai. 2014;97(9):954-62. Cited: PMID: 25536713
(29) Gillick BT, Feyma T, Menk J, Usset M, Vaith A, Wood TJ, et al. Safety and feasibility of transcranial direct current stimulation in pediatric hemiparesis: randomized controlled preliminary study. Phys Ther. 2015;95(3):337-49. https://doi.org/10.2522/ptj.20130565
(30) Carlson HL, Ciechanski P, Harris AD, MacMaster FP, Kirton A. Changes in spectroscopic biomarkers after transcranial direct current stimulation in children with perinatal stroke. Brain Stimul. 2018;11(1):94-103. https://doi.org/10.1016/j.brs.2017.09.007
(31) Gillick B, Rich T, Nemanich S, Chen CY, Menk J, Mueller B, et al. Transcranial direct current stimulation and constraint-induced therapy in cerebral palsy: A randomized, blinded, sham-controlled clinical trial. Eur J Paediatr Neurol. 2018;22(3):358-68. https://doi.org/10.1016/j.ejpn.2018.02.001
(32) Inguaggiato E, Bolognini N, Fiori S, Cioni G. Transcranial Direct Current Stimulation (tDCS) in Unilateral Cerebral Palsy: A Pilot Study of Motor Effect. Neural Plast. 2019;2019:2184398. https://doi.org/10.1155/2019/2184398
(33) Nemanich ST, Rich TL, Chen CY, Menk J, Rudser K, Chen M, et al. Influence of Combined Transcranial Direct Current Stimulation and Motor Training on Corticospinal Excitability in Children With Unilateral Cerebral Palsy. Front Hum Neurosci. 2019;13:137. https://doi.org/10.3389/fnhum.2019.00137
(34) Grecco LAC, Oliveira CS, Duarte NAC, Lima VLCC, Zanon N, Fregni F. Cerebellar transcranial direct current stimulation in children with ataxic cerebral palsy: A sham-controlled, crossover, pilot study. Dev Neurorehabil. 2017;20(3):142-8. https://doi.org/10.3109/17518423.2016.1139639
(35) Moura RCF, Santos C, Grecco LC, Albertini G, Cimolin V, Galli M, et al. Effects of a single session of transcranial direct current stimulation on upper limb movements in children with cerebral palsy: A randomized, sham-controlled study. Dev Neurorehabil. 2017;20(6):368-75. https://doi.org/10.1080/17518423.2017.1282050
(36) Jahan I, Muhit M, Hardianto D, Laryea F, Chhetri AB, Smithers-Sheedy H, et al. Epidemiology of cerebral palsy in low- and middle-income countries: preliminary findings from an international multi-centre cerebral palsy register. Dev Med Child Neurol. 2021;63(11):1327-36. https://doi.org/10.1111/dmcn.14926
(37) Hummel FC, Celnik P, Pascual-Leone A, Fregni F, Byblow WD, Buetefisch CM, et al. Controversy: Noninvasive and invasive cortical stimulation show efficacy in treating stroke patients. Brain Stimul. 2008;1(4):370-82. http://dx.doi.org/10.1016/j.brs.2008.09.003
(38) Bikson M, Grossman P, Thomas C, Zannou AL, Jiang J, Adnan T, et al. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimul. 2016;9(5):641-61. https://doi.org/10.1016/j.brs.2016.06.004
(39) Zewdie E, Ciechanski P, Kuo HC, Giuffre A, Kahl C, King R, et al. Safety and tolerability of transcranial magnetic and direct current stimulation in children: Prospective single center evidence from 3.5 million stimulations. Brain Stimul. 2020;13(3):565-75. https://doi.org/10.1016/j.brs.2019.12.025
(40) Alon G, Syron SC, Smith GV. Is Transcranial Electrical Stimulation (TCES) a Safe Intervention for Children with Cerebral Palsy?. Neurorehabil Neural Repair. 1998;12(2):65-71. http://dx.doi.org/10.1177/154596839801200204
(41) Kadosh RC, Levy N, O’Shea J, Shea N, Savulescu J. The neuroethics of non-invasive brain stimulation. Curr Biol. 2012;22(4):R108-11. https://doi.org/10.1016/j.cub.2012.01.013
(42) Lang N, Siebner HR, Ward NS, Lee L, Nitsche MA, Paulus W, et al. How does transcranial DC stimulation of the primary motor cortex alter regional neuronal activity in the human brain? Eur J Neurosci. 2005;22(2):495-504. https://doi.org/10.1111/j.1460-9568.2005.04233.x
(43) Ferreira IS, Costa BT, Ramos CL, Lucena P, Thibaut A, Fregni F. Searching for the optimal tDCS target for motor rehabilitation. J Neuroeng Rehabil. 2019;16:90. https://doi.org/10.1186/s12984-019-0561-5
(44) Furtado MAS, Ayupe KMA, Christovão IS, Sousa Junior RR, Rosenbaum P, Camargos ACR, et al. Physical therapy in children with cerebral palsy in Brazil: a scoping review. Dev Med Child Neurol. 2022;64(5):550-60. http://dx.doi.org/10.1111/dmcn.15067
(45) Torre CRMA. Bobath in Brazil: what is the best study design for intervention for children with cerebral palsy?. Dev Med Child Neurol. 2022;64(5):531. http://dx.doi.org/10.1111/dmcn.15147
(46) Jindal P, Macdermid JC, Rosenbaum P, Direzze B, Narayan A, Nayak SL. Treatment and re/habilitation of children with cerebral palsy in India: a scoping review. Dev Med Child Neurol. 2019;61(9):1050-60. https://doi.org/10.1111/dmcn.14211
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Copyright (c) 2023 Ana Carolina Freire, Vitor Nascimento dos Santos, Bibiana da Silveira dos Santos Machado, Juliana Barbosa Goulardins, Juliana Bilhar Marques
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License.
