restoring functional connectivity in hemiplegic cerebral palsy: a study of low-frequency rtms intervention

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.