Restoring Functional Connectivity in Hemiplegic Cerebral Palsy: A Study of Low-Frequency Rtms Intervention Publisher



Ghalyanchilangeroudi A^{1, 2} ; Yargholi E³ ; Soleimani M⁴ ; Shahrokhi A⁴ ; Mirbagheri MM^{1, 5, 6}
Source: Journal of Biomedical Physics and Engineering Published:2025

Abstract

Background: Hemiplegic Cerebral Palsy (HCP) causes significant motor impairments, due to disrupted Functional Connectivity (FC) between brain regions. Low-Frequency Repetitive Transcranial Magnetic Stimulation (LF-rTMS) has emerged as a potential therapeutic technique for restoring FC and motor recovery. Objective: This study aimed to evaluate the effects of LF-rTMS on FC in children with spastic HCP. Material and Methods: This Randomized Controlled Trial (RCT) included ten children with spastic HCP, aged 4 to 13 years. Six children received 12 sessions of LF-rTMS, while four in the control group underwent 12 sessions of sham stimulation. Functional Magnetic Resonance Imaging (fMRI) was used to assess intra-and interhemispheric FC during passive knee movements of the affected limb. Results: LF-rTMS induced region-specific reductions in interhemispheric FC, particularly between the contralesional ventral premotor area (cPMv) and both the ipsilesional primary somatosensory cortex (iS1) (for effect size: T=-2.60, P-value=0.048, FDR-corrected) and the ipsilesional primary motor area (iM1) (T=-2.45, P-value=0.048, FDR-corrected). These findings suggest modulation of interhemispheric motor-sensory pathways. Concurrently, localized increases in FC were observed in contralesional regions, and FC decreased between the ipsilesional Supplementary Motor Area (SMA) and the secondary somatosensory cortex (S2) (T=-3.11, P-value=0.041, FDR-corrected). Conclusion: LF-rTMS may modulate FC and hold promise as a rehabilitative intervention for improving motor function in children with HCP. © 2025, Shiraz University of Medical Sciences. All rights reserved.