Objective  To systematically evaluate the application of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) in children with spastic cerebral palsy.

Methods  Relevant literature about the application of LF-rTMS in children with spastic hemiplegia were searched electronically from CBM, CNKI, WanFang Data, VIP, The Cochrane Library, Scopus, PubMed, Embase, Web of Science from inception of the databases to September 1, 2023. A systematic review of the included articles was conducted and a Meta-analysis was performed using Revman 5.4 software.

Results  A total of 15 articles were included. LF-rTMS showed a certain rehabilitation effect on the upper limb function of spastic hemiplegia. Only the contralateral high-frequency transcranial magnetic stimulation combined with LF-rTMS would have adverse reactions. The results of Meta-analysis of 5 articles showed that LF-rTMS could improve the standing ability (area D) [MD=1.68, 95%CI(1.15, 2.20), P<0.001], walking, running and jumping ability (area E) [MD=1.96, 95%CI(1.36, 2.56), P<0.001] of children with spastic hemiplegia. LF-rTMS did not significantly improve fine motor function [MD=8.38, 95%CI

1.中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑性瘫痪康复专业委员会, 中国医师协会康复医师分会儿童康复专业委员会, 等. 中国脑性瘫痪康复指南(2022)第一章: 概论[J]. 中华实用儿科临床杂志, 2022, 37(12): 887-892. [Chinese Association of Rehabilitation Medicine Pediatric Rehabilitation Committee, Chinese Association of Rehabilitation of Disabled Persons Rehabilitation Committee for Cerebral Palsy, Chinese Medical Doctor Association Pediatric Rehabilitation Committee, et al. Chinese rehabilitation guidelines for cerebral palsy (2022) part 1: overview[J]. Chinese Journal of Applied Clinical Pediatrics, 2022, 37(12): 887-892.] DOI: 10.3760/cma.j.cn101070-20220505-00500.

2.李佳敏, 徐纯鑫, 陈岑, 等. 经颅磁刺激在脑性瘫痪儿童运动功能障碍康复中的应用研究进展[J]. 中国康复医学杂志, 2022, 37(3): 416-420. [Li JM, Xu CX, Chen C, et al. Application of transcranial magnetic stimulation in the rehabilitation of motor dysfunction in children with cerebral palsy[J]. Chinese Journal of Rehabilitation Medicine, 2022, 37(3): 416-420.] DOI: 10.3969/j.issn.1001-1242.2022.03.024.

3.Nardone R, Sebastianelli L, Ferrazzoli D, et al. Brain functional reorganization in children with hemiplegic cerebral palsy: assessment with TMS and therapeutic perspectives[J]. Neurophysiol Clin, 2021, 51(5): 391-408. DOI: 10.1016/j.neucli.2021.09.002.

4.中华医学会儿科学分会康复学组, 中国康复医学会物理治疗专委会. 儿童脑性瘫痪经颅磁刺激治疗专家共识[J]. 中华实用儿科临床杂志, 2022, 37(5): 333-337. [The Subspecialty Group of Rehabilitation, the Society of Pediatrics, Chinese Medical Association, Physical Therapy Committee of Chinese Association of Rehabilitation Medicine. Expert consensus on transcranial magnetic stimulation therapy for children with cerebral palsy[J]. Chinese Journal of Applied Clinical Pediatrics, 2022, 37(5): 333-337.] DOI: 10.3760/cma.i.cn101070-20220113-00050.

5.Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions[M]. Version 5.1.0. New Jersey: John Wiley & Sons, 2011: 4.

6.Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials[J]. Phys Ther, 2003, 83(8): 713-721. DOI: 10.1093/ptj/83.8.713.

7.张杨萍. 不同频率重复经颅磁刺激对痉挛型偏瘫脑瘫患儿运动功能影响的研究[D]. 佳木斯: 佳木斯大学, 2018. [Zhang YP. Research on the effect of different frequency repetitive transcranial magnetic stimulation on motor function of children with spastic hemiplegic cerebral palsy[D]. Jiamusi: Jiamusi University, 2018.] https://kns.cnki.net/KCMS/detail/detail.aspx?dbname=CMFD201901&filename=1018876842.nh.

8.李海峰, 尹宏伟, 邹艳, 等. 重复经颅磁刺激对痉挛偏瘫型脑瘫患儿肢体运动功能的影响[J]. 中华物理医学与康复杂志, 2016, 38(6): 433-435. [Li HF, Yin HW, Zou Y, et al. Effects of repetitive transcranial magnetic stimulation on limb motor function in children with spastic hemiplegic cerebral palsy[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2016, 38(6): 433-435.] DOI: 10.3760/cma.i.issn.0254-1424.2016.06.009.

9.吴野, 巩尊科, 李新剑, 等. 不同模式经颅磁刺激对痉挛型偏瘫脑性瘫痪患儿上肢运动功能的影响[J]. 中国康复医学杂志, 2019, 34(11): 1368-1370. [Wu Y, Gong ZK, Li XJ, et al. Effects of different modes of transcranial magnetic stimulation on upper limb motor function in children with spastic hemiplegic cerebral palsy[J]. Chinese Journal of Rehabilitation Medicine, 2019, 34(11): 1368-1370.] DOI: 10.3969/jissn1001-1242.2019.11.021.

10.张杨萍, 张丽华, 李雪梅, 等. 双侧与单侧重复经颅磁刺激对痉挛型偏瘫脑瘫患儿运动功能影响的对比研究[J]. 中国儿童保健杂志, 2018, 26(5): 533-536. [Zhang YP, Zhang LH, Li XM, et al. Comparative study on the effect of bilateral and unilateral repetitive transcranial magnetic stimulation on motor function of children with spastic hemiplegia cerebral palsy[J]. Chinese Journal of Child Health Care, 2018, 26(5): 533-536.] DOI: 10.11852/zgetbjzz2018-26-05-19.

11.宋钰娟, 朱敏杰. 探讨高频结合低频重复经颅磁刺激对痉挛型偏瘫脑瘫患儿运动功能的影响[J]. 四川解剖学杂志, 2019, 27(4): 54-55. [Song YJ, Zhu MJ. Exploring the effects of high-frequency combined with low-frequency repetitive transcranial magnetic stimulation on motor function in children with spastic hemiplegic cerebral palsy[J]. Sichuan Journal of Anatomy, 2019, 27(4): 54-55.] DOI: 10.3969/i.issn.1005-1457.2019.04.026.

12.梁冠军, 顾琴, 李明娣, 等. 重复经颅磁刺激联合强制性诱导疗法对偏瘫型脑瘫患儿上肢功能的影响[J]. 中华物理医学与康复杂志, 2020, 42(6): 515-518. [Liang GJ, Gu Q, Li MD, et al. Repetitive transcranial magnetic stimulation can improve the effectiveness of constraint-induced movement therapy for hemiplegic children with cerebral palsy[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2020, 42(6): 515-518.] DOI: 10.3760/cma.j.issn.0254-1424.2020.06.007.

13.王敏, 李新剑, 郑雪芝, 等. 低频rTMS联合生物反馈疗法对偏瘫型脑瘫患儿大脑皮质运动区兴奋性及上肢运动功能的改善作用[J]. 山东医药, 2019, 59(30): 57-59. [Wang M, Li XJ, Zheng XZ, et al. Improvement effects of low-frequency rTMS combined with biofeedback therapy on the excitability of cortical motor areas and upper limb motor function in children with hemiplegic cerebral palsy[J]. Shandong Medicine Journal, 2019, 59(30): 57-59.] DOI: 10.3969/i.issn.1002-266x.2019.30.016.

14.朱青, 吕露芬, 门爽. rTMS联合生物反馈疗法对偏瘫型脑瘫患儿上肢运动功能的影响[J]. 甘肃医药, 2022, 41(11): 995-997. [Zhu Q, Lyu LF, Men S. Effect of rTMS combined with biofeedback therapy on upper limb motor function in children with hemiplegic cerebral palsy[J]. Gansu Medical Journal, 2022, 41(11): 995-997.] DOI: 10.15975/j.cnki.gsyy.2022.11.028.

15.Kirton A, Andersen J, Herrero M, et al. Brain stimulation and constraint for perinatal stroke hemiparesis: the PLASTIC CHAMPS trial[J]. Neurology, 2016, 86(18): 1659-1667. DOI: 10.1212/WNL.0000000000002646.

16.Kuo HC, Zewdie E, Ciechanski P, et al. Intervention-induced motor cortex plasticity in hemiparetic children with perinatal stroke[J]. Neurorehabil Neural Repair, 2018, 32(11): 941-952. DOI: 10.1177/1545968318801546.

17.Gillick BT, Krach LE, Feyma T, et al. Primed low-frequency repetitive transcranial magnetic stimulation and constraint-induced movement therapy in pediatric hemiparesis: a randomized controlled trial[J]. Dev Med Child Neurol, 2014, 56(1): 44-52. DOI: 10.1111/dmcn.12243.

18.Wu Q, Peng T, Liu L, et al. The effect of constraint-induced movement therapy combined with repetitive transcranial magnetic stimulation on hand function in preschool children with unilateral cerebral palsy: a randomized controlled preliminary study[J]. Front Behav Neurosci, 2022, 16: 876567. DOI: 10.3389/fnbeh.2022.876567.

19.Kirton A, Chen R, Friefeld S, et al. Contralesional repetitive transcranial magnetic stimulation for chronic hemiparesis in subcortical paediatric stroke: a randomised trial[J]. Lancet Neurol, 2008, 7(6): 507-513. DOI:  10.1016/S1474-4422(08)70096-6.

20.Rich TL, Menk J, Krach LE, et al. Repetitive transcranial magnetic stimulation/behavioral intervention clinical trial: long-term follow-up of outcomes in congenital hemiparesis[J]. J Child Adolesc Psychopharmacol, 2016, 26(7): 598-605. DOI: 10.1089/cap.2015.0157.

21.Gupta J, Gulati S, Singh UP, et al. Brain stimulation and constraint induced movement therapy in children with unilateral cerebral palsy: a randomized controlled trial[J]. Neurorehabil Neural Repair, 2023, 37(5): 266-276. DOI: 10.1177/15459683231174222.

22.Elbanna ST, Elshennawy S, Ayad MN. Noninvasive brain stimulation for rehabilitation of pediatric motor disorders following brain injury: systematic review of randomized controlled trials[J]. Arch Phys Med Rehabil, 2019, 100(10): 1945-1963. DOI: 10.1016/j.apmr.2019.04.009.

23.Lefaucheur JP, André-Obadia N, Antal A, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS)[J]. Clin Neurophysiol, 2014, 125(11): 2150-2206. DOI: 10.1016/j.clinph.2014.05.021.