Safety and Feasibility of Transcranial Magnetic Stimulation as an Exploratory Assessment of Corticospinal Connectivity in Infants after Perinatal Brain Injury: An Observational Study

Samuel T Nemanich, Chao-Ying Chen, Mo Chen, Elizabeth Zorn, Bryon Mueller, Colleen Peyton, Jed T Elison, James Stinear, Raghu Rao, Michael Georgieff, Jeremiah Menk, Kyle Rudser, Bernadette Gillick

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11 Scopus citations


Background Perinatal brain injuries often impact the corticospinal system, leading to motor impairment and cerebral palsy. Although transcranial magnetic stimulation (TMS) has been widely used to study corticospinal connectivity in adults and older children, similar studies of young infants are limited. Objectives The objective was to establish the safety and feasibility of advanced TMS assessments of the corticospinal connectivity of young infants with perinatal brain injury. Design This was a pilot, cross-sectional study of 3- to 12-month-old (corrected age) infants with perinatal stroke or intracranial hemorrhage. Methods Six participants (2 term, 4 preterm) were assessed with stereotactic neuronavigation-guided TMS. Single-pulse TMS was applied to each hemisphere and responses were recorded simultaneously from both upper limbs. During data collection, vital signs and stress responses were measured to assess safety. Developmental motor outcomes were evaluated using the General Movements Assessment and Bayley Scales of Infant and Toddler Development (3rd edition). A clinical diagnosis of cerebral palsy was recorded, if available. Results No adverse events occurred during TMS testing. All sessions were well tolerated. Contralateral motor evoked responses were detected in 4 of 6 participants. Both contralateral and ipsilateral responses were observed in 2 of 6 participants. Limitations TMS responses were not obtained in all participants. This could be related to the location of brain injury or developmental stage of the corticospinal system controlling the wrist flexor muscle group from which responses were recorded. Conclusions This study provides a summary of the framework for performing novel TMS assessments in infants with perinatal brain injury. Implementing this approach to measure corticospinal connectivity in hypothesis-driven studies in young infants appears to be justified. Such studies could inform the characterization of corticospinal development and the neural mechanisms driving recovery following early interventions.

Original languageEnglish (US)
Article numberpzz028
Pages (from-to)689-700
Number of pages12
JournalPhysical therapy
Issue number6
StatePublished - Jun 1 2019

Bibliographical note

Funding Information:
This study was funded by the National Institutes of Health (NIH) Eunice Kennedy Shriver National Institutes of Child Health and Development K01 Award (HD078484-01A1), the Cerebral Palsy Alliance Research Foundation, the University of Minnesota’s Discovery, Research, and Innovation Economy (MnDRIVE) initiative, the University of Minnesota Academic Health Center, the University of Minnesota Center for Magnetic Resonance Research (P41 EB015894 and 1S10OD017974-01), and the University of Minnesota Clinical and Translational Science Institute (National Center for Advancing Translational Sciences of the National Institutes of Health-UL1TR002494).


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