Repetitive TMS and Occupational Therapy in Children and Young Adults With Chronic Hemiparesis

Motor Control Enhancement Through Repetitive Transcranial Magnetic Stimulation Plus Rehabilitation in Hemiparetic Cerebral Palsy and Stroke

The purpose of this study is to determine whether Repetitive Transcranial Magnetic Stimulation (rTMS) can augment occupational therapy in improving motor function in children (10 years of age or older) and young adults (< 21 years of age) with chronic hemiparesis from either stroke or cerebral palsy.

RTMS is a noninvasive technology that can induce changes in brain function that may lead to functional improvement in people with hemiparesis. This is a randomized, double-blinded, sham-controlled rTMS study in conjunction with intensive daily occupational therapy (OT) for 2 weeks to improve motor function in hemiparetic patients. Participants will be followed for at least 12 weeks after rTMS to detect any clinical change. The sham group participants will be offered an open-label active rTMS treatment plus OT after the 12 week assessment.

Inclusion Criteria:

• Age ≥ 10 years; < 21 years
• Hemiparesis
• Manual Ability Classification System (MACS) level I through IV
• Provision of written informed consent by the patient and/or guardian, including understanding that insurance may be billed for the occupational therapy
• Written assent form signed by participants younger than 18 years of age

Exclusion Criteria:

• Underlying degenerative or metabolic disorder or supervening medical illness
• Severe depression or other psychiatric disorder
• Any participant who is pregnant
• Any contraindication to TMS (i.e., intracranial metal implants, shunts, ports, pacemaker, baclofen pumps)
• Any changes or addition of neuropsychiatric medications within 1 month of starting the study or during course of the study (if applicable)
• Any botulinum toxin (Botox, Myobloc) or phenol injection within the last 3 months prior to the study or during the course of the study (if applicable)
• Any upper extremity surgery within the last 6 months prior to the study or scheduled during the course of the study (if applicable)