Transcranial magnetic stimulation as a diagnostic and therapeutic tool in cerebral palsy

Purpose
Cerebral palsy (CP) is one of the leading causes of child disability, which profoundly affects the lives of whole families and contributes to the burden of health care. Despite the extensive rehabilitative, surgical and other therapeutic efforts of an array of specialists, a significant proportion of patients remain severely disabled. Transcranial magnetic stimulation (TMS) is a non-invasive diagnostic tool in various diseases of the cerebral cortex and cortico-spinal tract (CST). Repetitive TMS (rTMS) is able to induce a long-lasting cerebral plasticity, which is associated with a therapeutic effect in a number of psychiatric and neurological diseases. This article reviews the diagnostic findings gained with TMS in CP as well as therapeutic trials performed with rTMS.

Views
The absence of responses in the motor cortex in the first months of life, as revealed by TMS, may predict the development of CP in children at risk. In a proportion of children with the unilateral form of CP, TMS documents the pathological preservation of ipsilateral, cortico-spinal connections from the non-lesioned hemisphere, which is associated with poor outcome. rTMS seems to be a safe method with significant therapeutic potential in CP. The data published so far reveals an almost unanimously significant therapeutic benefit in motor performance over placebo. However, the studies conducted to date have almost without exception involved children with unilateral palsy, and have focused nearly exclusively on therapy for motor symptoms.

Conclusions
Magnetic stimulation brings significant diagnostic and therapeutic effects in CP. However, more studies that go beyond the limits specified above are still awaited.