Arun Mukherjee

Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients

Abstract Spastic cerebral palsy (CP) is the one of most common neurological disorders occurring due to damage to the immature brain or any other brain lesion at the time of birth. To aid in making the life of the CP patient meaningful, several interventions such as medical, surgical and rehabilitation have been employed to date. Besides these, recently repetitive Transcranial magnetic stimulation (r-TMS) is a new found approach which is being employed for treating various neurological and psychological conditions. The aim of this study was to observe the effects of r-TMS on muscle spasticity in CP patients by stimulating the motor cortex area of the brain, which is responsible for muscle movements. In this study, 20 subjects diagnosed with CP were recruited and 10 each were placed in two groups, namely the research group (RG) (mean age, height and weight were 7.99 (SD = 4.66) years, 116.7 (SD = 23.57) cm and 21.40 (SD = 10.95) kg, respectively) and the control group (CG) (mean age, height and weight were 8.41 (SD = 4.32) years, 107.9 (SD = 26.33) cm, 21.40 (SD = 12.63) kg, respectively). r-TMS frequencies of 5u2009Hz and 10u2009Hz were administered for 15u2009min daily to patients in RG followed by standard therapy (ST) of 1u2009h duration daily for 20 days. Moreover, the patients in the control group (CG) were given only standard therapy (ST) of 1u2009h duration for 20 days. Modified Ashworth Scale (MAS) was used as an outcome measure to determine the level of muscle spasticity. A pre- assessment of MAS score was performed on both RG and CG to determine the level of spasticity prior to starting therapy; and similarly post-assessment after 20 days was done to observe the changes post-therapy. Statistical analysis of pre vs post MAS scores showed that few muscles showed reduction in muscle tightness after administering only ST in the CG. On the contrary, the RG that underwent r-TMS therapy combined with ST showed a significant decrease (pu2009<u20090.05) in muscle tightness for all the muscles selected for the therapy.

Transcranial Magnetic Stimulation Therapy in Spastic Cerebral Palsy Children Improves Motor Activity

Transcranial magnetic stimulation (TMS) is a new interventional tool used in the study of neuronal activity and treatment of psychiatric disorders. Repetitive TMS (rTMS) is a non-invasive technique of stimulating the brain employing magnetic pulses. Recent research has demonstrated the efficacy of rTMS in facilitating motor functions. Using these evidences, we studied the effectiveness of rTMS in improving motor activity in spastic cerebral palsy (CP) children. CP is a neuro-developmental disorder of movement and posture that is caused by injury to the developing brain that restrict activities of daily living. In the quest to treat CP, several interventions are used among which physical therapy is the mainstay therapy. In this study, we selected 45 spastic CP children and divided them randomly into three groups-the reference group (RG) that was provided only physical therapy (PT) for 30 minutes daily for 20 days; the interventional group (IG) that was administered rTMS frequency of 5Hz (IG-A) and 10Hz (IG-B) for 15 minutes (1500 pulses) daily followed by PT as in RG. Gross motor function measure (GMFM) was used as assessment tool to evaluate the motor performance. Prior to start of therapy, pre-assessment of GMFM was performed on all participants and post assessment after completion of 20 sessions. The result was statistically significant in all three groups (p<0.001) and the mean change demonstrated 0.64%, 1.75% and 2.59% improvement in motor activity among participants in RG, IG-A and IG-B respectively. The study demonstrated positive effect of rTMS in improving motor activity when combined with PT.

Effect of Repetitive Transcranial Magnetic Stimulation on Hand Function of Spastic Cerebral Palsy Children

Repetitive Transcranial magnetic stimulation (rTMS) is emerging as a new investigation as well as treatment tool for various neurological and psychiatric diseases. Recent studies showed its application as treatment tool in movement disorders, where rTMS stimulation on primary motor cortex alters physiological patterns of motor threshold; motor evoked potential and cortical plasticity which induces motor activity. Recent studies on rTMS combined with rehabilitation therapy demonstrated functional improvement in motor activities of spastic cerebral palsy (sCP) children. Thus, this study was designed to evaluate the effect of rTMS on hand function of sCP patients. nForty-five children diagnosed as sCP participated in this study after written consent from their parents or guardians. They were divided into three groups- control (CG) and interventional group (IG-A and IG-B). Participants in CG were provided only physical therapy (PT) of 30 minutes duration daily for 20 days and those in IG were administered rTMS frequency of 5Hz (IG-A) and 10Hz (IG-B) for 15 minutes consisting of 1500 pulses daily for 20 days; followed by PT as given to CG. Quality of upper extremity skill test (QUEST) scoring was used for evaluating the improvement in hand function of sCP patients. The pre (before starting any therapy) versus post (after completion of 20 sessions) mean QUEST score between different groups were statistically significant (p<0.01) and the mean change was 0.61, 2.46 and 2.87 in CG, IG-A and IG-B respectively. nHowever, encouraging functional improvement in hand function was observed in diplegic patients in the age group of 2-6 years employing 5Hz frequency and higher frequency (10Hz) induced better activity in hemiplegic and quadriplegic patient of older age groups (7-16 years).

Power Spectral Study of EEG Signal from the Frontal Brain Area of Autistic Children

Autism or autism spectrum disorder (ASD) represents complex developmental disabilities characterized by deficits in social communications, interactions, and cognitive development. The prevalence of ASD shows a growing trend both in developed and developing countries. ASD occurs due to improper brain development in early life and individuals characterized as ASD possesses abnormal brain activity that is commonly studied using electroencephalography (EEG). Our present work analyzes the EEG of ASD children from the frontal lobe of the brain that is responsible for social, emotion, and cognitive functions, which was compared with the EEG signals of normal healthy children. The power spectra (PS) of EEG signal were obtained using fast Fourier transformation (FFT) algorithm in MATLAB. EEG recording was performed on all the ten selected children (five ASD and five normal) using two electrodes placed on F3 and F4. The artifact-free EEG signals of 10 min duration were extracted and used for obtaining PS. The PS revealed high-intensity power peak at frequency 50 Hz, for all healthy children; but in case of ASD participants, there existed two peaks at 100 and 50 Hz. The intensity of 50 Hz peak in ASD cases was not as intense as those of normal children but the 100 Hz peak was highly intense. The existence of high-intensity peaks in ASD can be attributed to the imbalance in high-frequency EEG rhythm that is responsible for perpetual and cognitive processing in humans.

Neuromodulatory effect of repetitive transcranial magnetic stimulation pulses on functional motor performances of spastic cerebral palsy children

Abstract Background: Neuromodulation is emerging as a new therapeutic field towards treatment of neurological disorders through advances in medical devices. Repetitive Transcranial Magnetic Stimulation (rTMS) is one such neuromodulatory device that has received increasing interest as a tool for modulating cortical excitability that influence motor activity in both normal and diseased population. However, the therapeutic effect of rTMS varies depending on stimulation frequency, intensity, pulse trains, duration, etc. Our previous studies had already demonstrated that higher frequency of 10u2009Hz was effective in improving the motor activity of spastic CP patients. Objective: This study was aimed to evaluate the effect of different rTMS pulses on gross motor performance of spastic CP patients. Method: Thirty spastic CP patients were divided equally into three groups P1500, P2000 and P2500 with mean age (in years) 7.7u2009±u2009SD4.4, 6.8u2009±u2009SD5.3 and 7.2u2009±u2009SD5.1 respectively. Gross Motor Function Measure (GMFM) was employed as an outcome measure to assess the motor performance. Constant rTMS frequency of 10u2009Hz was delivered to each participant but the number of stimulation pulse varied according to the groups; which were 1500, 2000 and 2500 pulses for P1500, P2000 and P2500 group respectively. rTMS therapy of 15u2009minutes duration was followed by physical therapy of 30u2009minutes daily for 20u2009days. Result: Statistical analysis of pre versus post GMFM scores of different groups revealed significant result (pu2009<u2009.001) and the improvement in functional motor activity was 2.33% in P1500, 3.58% in P2000 and 5.17% in P2500 group. Interpretation: The result demonstrated modulatory effect of rTMS pulse by improving motor function of spastic CP patients.

Effect of Repetitive Transcranial Magnetic Stimulation Pulses on Muscle Spasticity of Cerebral Palsy Children

Background: Spasticity is a common contributor to the quality of life of children with CP as it leads to musculoskeletal problems; however, it had been proved that removal of spasticity can improve motor functions in these children; thus, several invasive and non-invasive approaches are applied. Repetitive Transcranial magnetic stimulation (rTMS) is one such non-invasive brain stimulation approach that can induce motor functions in children with movement disorder depending on stimulation intensity and pulses. nObjective: This study was aimed to evaluate the effect of different rTMS pulses on muscle spasticity of spastic cerebral palsy (CP) children. nMethod: Thirty spastic CP children participated in this study which was divided equally into three groups P15, P20 and P25 on the basis of stimulating pulses of 1500, 2000 and 2500 respectively. Modified Ashworth Scale (MAS) was employed for assessing the degree of muscle spasticity and prior to start of rTMS therapy, pre assessment of MAS was performed on selected muscles of both lower and upper limbs. rTMS therapy was administered at 10 Hz frequency to each of the participants for 15 min duration for 20 days followed by physical therapy (PT) of 30 min duration daily for 20 days. After completion of the therapy sessions, post-assessment of MAS on exactly the same muscles were recorded. nResult: Statistically significant result (p<0.5) was found on different muscles that responded to different rTMS pulses between groups along with reduction in muscle spasticity. nConclusion: The result demonstrated that rTMS pulse of 1500 and 2000 was effective in both upper and lower limb muscles of spastic CP children but pulse of 2500 was effective in children with severe muscle tightness falling in higher age group range.

Effectiveness of Brahmi in Various Illnesses: Review Paper

Plants have been used as treatments for thousands of years, based on experience and folk remedies and continue to draw wide attention for their role in the treatment of mild and chronic diseases. In these eras, focus on plant research has increased all over the world and a large body of evidence has been accumulated to highlight the immense potential of medicinal plants used in various traditional systems of medicine. In various medicinal plants Centella asiatica is one of the most useful plants seen in Ayurveda medicines. Centella asiatica (commonly known as Brahmi in India) is an imperative medicinal drug which possesses significant medicinal properties, especially those involving cognition. It has been extensively known as a brain tonic that promotes cerebrum development. This herb is recommended for the treatment of various skin conditions such as leprosy, lupus, varicose ulcers, eczema, psoriasis, diarrhea, fever, amenorrhea, diseases of the female genitourinary tract and also for relieving anxiety and improving cognition. The present paper reviews Brahmi (Centella asiatica) as a medicinal plant and highlights its benefits in various health problems.

Transcranial Magnetic Stimulation in spastic Cerebral Palsy helps achieve developmental milestone: A case report

Developmental disability in a growing child limits the n attainment of certain functions such as motor, n communication, perpetual and cognitive skills. Cerebral n Palsy (CP) is one such developmental disability that hinders n the movement and activities of daily living of the affected n child. In order to treat this disorder, several interventional n tools are available which has its own pros and cons. n Repetitive Transcranial magnetic stimulation (rTMS) is a n new noninvasive tool employed for the treatment of CP due n to its neuromodulatory effect that facilitates motor memory n formation, motor performance and motor learning in n individuals. In this report, a promising effect of rTMS n therapy is discussed wherein a wheelchair ridden patient n was able to crawl, kneel and move after two rounds of n treatment procedure.