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



Ghalyanchilangeroudi A1, 2 ; Yargholi E3 ; Soleimani M4 ; Shahrokhi A4 ; Mirbagheri MM1, 5, 6
Authors
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Authors Affiliations
  1. 1. Department of Medical Physics & Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Research Center for Biomedical Technologies and Robotics (RCBTR), Advanced Medical Technologies and Equipment Institute (AMTEI), University of Medical Science (TUMS), Tehran, Tehran, Iran
  3. 3. Laboratory of Biological Psychology, Department of Brain and Cognition, Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, 3714, Belgium
  4. 4. Department of Basic Science, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
  5. 5. Neural Engineering and Rehabilitation Research Center, Tehran, Iran
  6. 6. Department of Physical Medicine and Rehabilitation, Northwestern University, United States

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.