Objective: To assess the effectiveness of neurostimulation in enhancing motor function in children with perinatal stroke and hemiparetic cerebral palsy.

Background: Neuromodulation techniques, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have been investigated as complementary approaches to improve hemiparesis in neonatal perinatal stroke by enhancing brain plasticity. No meta-analysis has been conducted on the topic to date. Herein, we aim to perform a systematic review and meta-analysis assessing the effects of neuromodulation on perinatal stroke hemiparesis.

Method: We searched PubMed, Web of Science, Cochrane Library, and Scopus for randomized clinical trials. We analyzed the following outcomes: Assisting Hand Assessment (AHA), Canadian Occupational Performance Measure – Performance (COPM-P), and COPM – Satisfaction. Data were examined using the Mantel–Haenszel method, 95% confidence intervals (CIs), and mean differences (MDs). R Studio, version 4.4.2, was used for statistical analysis.

Results: Three sham-controlled trials were included, comprising 158 patients. We found no differences in: the AHA scale (MD 0.66; 95% CI -1.34 to 2.67; p=0.51;I²=14.3%); the COPM-P (MD 0.67; 95% CI -0.74 to 2.07; p=0.351, I²=73.2%): and COPM-S (MD 0.84; 95% CI -1.10 to 2.78; p = 0.394; I² = 78.4%). 

Conclusion: Non-invasive brain stimulation may not improve upper limb function in children with hemiparesis due to perinatal stroke. This meta-analysis found no significant benefit of neuromodulation over sham stimulation in those patients. Further randomized clinical trials are needed for a deeper assessment of neuromodulation in such patients.

Figura 1: Forest plot for AHA.

Figura 2: Forest plot for COPM-P..

Figura 2: Forest plot for COPM-S.

References: Hilderley AJ, Dunbar M, Andersen J, et al. Neuromodulation for Children With Hemiparesis and Perinatal Stroke: A Randomized Clinical Trial. JAMA Neurol. 2025;82(3):267–275. doi:10.1001/jamaneurol.2024.4898
Kirton A, Andersen J, Herrero M, et al. Brain stimulation and constraint for perinatal stroke hemiparesis: The PLASTIC CHAMPS Trial. Neurology. 2016;86(18):1659-1667. doi:10.1212/WNL.0000000000002646
Kirton A, Ciechanski P, Zewdie E, et al. Transcranial direct current stimulation for children with perinatal stroke and hemiparesis. Neurology. 2017;88(3):259-267. doi:10.1212/WNL.0000000000003518
Metzler MJ, Haspels E, Brunton L, Andersen J, Pritchard L, Herrero M, Hodge J, Kirton A. Goals of children with unilateral cerebral palsy in a brain stimulation arm rehabilitation trial. Dev Med Child Neurol. 2021 May;63(5):584-591. doi: 10.1111/dmcn.14763.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-efficacy-of-neuromodulation-for-motor-recovery-in-children-with-hemiparesis-due-to-perinatal-stroke-a-systematic-review-and-meta-analysis/