Clinical application of transcranial magneticstimulation in children

Abstract

Transcranial magnetic stimulation (TMS) is a non-invasive, painless neurotechnology that can be used to investigate and therapeutically modulate brain cortical activity in children with neurological disorders. The method is based on electromagnetic induction, which stimulates action potentials in cortical neurons. Diagnostic TMS enables the assessment of cortical excitability and corticospinal tract integrity by measuring parameters such as motor evoked potential threshold, latency, amplitude, and silent period. Therapeutic protocols include low-frequency repetitive TMS (rTMS) with pulse frequencies below 1 Hz to inhibit excessive cortical activity, and high-frequency stimulation (above 1 Hz) to facilitate hypoactive regions through long-term potentiation and depression of synaptic transmission. rTMS has been applied in cerebral palsy and post-stroke recovery to improve motor function; in epilepsy to reduce seizure frequency; in migraine to abort headache attacks; in autism spectrum disorders to improve social behavior, etc. rTMS is most commonly added to standard therapy. Evidence for the efficacy of rTMS is present in literature, but further clinical experience accumulation is needed. The method has an excellent safety profile, with risk of seizure induction below 0.05%, in case of  properly followed application protocols; and mild transient side effects observed in less than 3% of procedures.

Keywords: transcranial magnetic stimulation, cerebral palsy, neuroplasticity, neuromodulation

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Address for correspondence::

F. Galabova

Department of Pediatrics “Prof. Ivan Andreev”, Medical University – Plovdiv

15a “Vasil Aprilov”, Blvd.

4002, Plovdiv

e-mail: Fani.galabova@gmail.com