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Transcranial Magnetic Stimulation in Children
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Transcranial Magnetic Stimulation in Children Marjorie A. Garvey, MB, BCh and Neuroscience Research Center, National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 Volker Mall, MB, PhD Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Mathildenstraβe 1, D - 79104 Freiburg Abstract Developmental disabilities (e.g. attention deficit disorder; cerebral palsy) are frequently associated with deviations of the typical pattern of motor skill maturation. Neurophysiologic tools, such as transcranial magnetic stimulation (TMS), which probe motor cortex function, can potentially provide insights into both typical neuromotor maturation and the mechanisms underlying the motor skill deficits in children with developmental disabilities. These insights may set the stage for finding effective interventions for these disorders. We review the literature pertaining to the use of TMS in pediatrics. Most TMS-evoked parameters show age-related changes in typically developing children and some of these are abnormal in a number of childhood-onset neurological disorders. Although no TMS-evoked parameters are diagnostic for any disorder, changes in certain parameters appear to reflect disease burden or may provide a measure of treatment-related improvement. Furthermore, TMS may be especially useful when combined with other neurophysiologic modalities (e.g. fMRI). However, much work remains to be done to determine if TMS-evoked parameters can be used as valid and reliable biomarkers for disease-burden, the natural history of neurological injury and repair, and the efficacy of pharmacological and rehabilitation interventions. Keywords Transcranial Magnetic Stimulation; Maturation; Children; Motor Cortex Function; Developmental Disorders Introduction Transcranial magnetic stimulation (TMS) has proved to be a useful probe of motor function in adults. In this article we review the utility of TMS as a probe of motor function in both typically developing children and in those with anomalous motor development. First, we briefly review normal neuromotor maturation and give an overview of those aspects of the central nervous system that undergo structural changes during childhood. Following this we discuss methods used to assess brain function focusing on TMS. Finally, we review studies which have examined the utility of TMS to gain insights into the neural substrates of developmental Corresponding Author: Marjorie A. Garvey, MB, BCh, Neuroscience Research Center, National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20016, Ph: 202-877-1021, Fax: 202-829-6831, e-mail: marjorie.garvey@medstar.net. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author Manuscript Clin Neurophysiol. Author manuscript; available in PMC 2009 May 1. Published in final edited form as: Clin Neurophysiol. 2008 May ; 119(5): 973–984. NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscript

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