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The Effect of Transcranial Magnetic Stimulation on the Autonomic Nervous System in Pediatric Stroke
Author(s) -
Chantigian Daniel,
Rich Tonya,
Chen ChaoYing,
Lixandrao Maira,
Gillick Bernadette,
KellerRoss Manda
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.862.6
Subject(s) - medicine , stroke (engine) , hemiparesis , transcranial magnetic stimulation , heart rate , autonomic nervous system , cardiology , physical medicine and rehabilitation , stimulation , anesthesia , blood pressure , mechanical engineering , angiography , engineering
Transcranial Magnetic Stimulation (TMS) is used to study neurodevelopmental disorders including pediatric hemiparesis secondary to perinatal stroke and periventricular leukomalacia. Case reports of vasovagal syncope with TMS in adults and children suggest that TMS may have an effect on the autonomic nervous system (ANS); however, the effect of TMS on the ANS in children with stroke is unknown. Objective Determine blood pressure (BP) and heart rate (HR) responses to single‐pulse TMS in children with perinatal stroke and periventricular leukomalacia resulting in hemiparesis. Methods As a part of a larger study, autonomic data was recorded from 16 participants (9 females, 13 ± 4 yrs, mean ± SD) at rest and during resting motor threshold (RMT) testing of the primary motor cortex. RMT testing occurred for 15 ± 11 minutes. HR was continuously recorded via a 3‐lead electrocardiogram and BP was continuously recorded via a finger plethysmography device (AD Instruments, Colorado Springs, CO). Eight participants were excluded from the BP analysis because of unreliable data due to spasticity (n=5) and a lack of correct finger cuff size (n=3) in the monitoring hand. Autonomic data recorded during the first five stimulations were averaged and defined as the beginning of the stimulation session, while data recorded during the last five stimulations were averaged and defined as the end of the stimulation session. Results Average HR was similar at rest (85 ± 12 bpm) compared with the beginning of the stimulation session (82 ± 12 bpm, p = 0.06) and the end of the stimulation session (82 ± 9 bpm, p = 0.06). Average mean arterial pressure (MAP) was also similar at rest (79 ± 5 mmHg) compared with the beginning of the stimulation session (83 ± 7 mmHg, p = 0.29) and the end of the stimulation session (87 ± 18 mmHg, p = 0.24). Individual responses to TMS administration were variable and ranged from −17 to + 5 bpm for HR and from − 9 to + 32 mmHg for MAP. Conclusion Although on average TMS did not alter HR and BP in children with stroke, variations in individual responses to TMS were observed, suggesting that the ANS in some individuals might be more responsive to TMS administration than others. It is unclear if the observed changes in individual responses are a direct result of the stimulation or due to anticipation of receiving TMS (e.g. anxiety or stress). Because of the variations in individual HR and BP responses to TMS administration, monitoring the ANS may be important for identifying individuals that are at risk for syncopal events.