Abstract 032: TOPSS: TOlerability of tDCS in Pediatric Stroke Survivors

IntroductionPediatric cerebrovascular disease is a leading cause of morbidity in children. Childhood‐onset stroke is defined as stroke occurring after the first month of life and accounts for about half of pediatric stroke. Most children with childhood‐onset stroke will survive to adulthood, but ~75% of those with childhood‐onset stroke experience long‐term neurologic impairments, including motor weakness and cognitive difficulties. Hemiparesis is a frequent complication of childhood‐onset stroke and is tremendously debilitating. Transcranial direct current stimulation (tDCS) is a promising and inexpensive non‐invasive neuromodulation technique that can be used to augment neuronal plasticity as an adjunctive rehabilitation therapy.MethodsParticipants with chronic hemiparesis from childhood‐onset ischemic or hemorrhagic stroke were prospectively enrolled in this study. All study participants received 5 sessions of tDCS lasting for 20 minutes each while engaging in 1‐on‐1 occupational therapy with a certified occupational therapist. tDCS sessions were followed by an additional 1 hour and 40 minutes of rehabilitation therapy focused on the impaired arm. The amplitude of stimulation was increased daily as follows: sham stimulation on day 1, 0.5mA on day 2, 1.0mA on day 3, 4, and 5. Participants aged 13‐19 years had stimulation further increased to 1.5mA on days 4 and 5. The primary objective measures were safety and tolerability which were assessed with percent study completion, participant tolerability questionnaires, and pre‐ and post‐ stimulation vital signs. Secondary outcome measures included arm function measured using the Fugl‐Meyer Assessment of the Upper Extremity (FMA‐UE) and box and blocks test. Satisfaction was measured using the Canadian Occupational Performance Measure (COPM). A data safety and monitoring board comprised of a pediatric neurologist and pediatric physiatrist reviewed all stimulation monitoring sheets.ResultsFive participants completed the study. Blood pressure and pulse measurements were within normal limits for all participants for all pre‐ and post‐therapy measurements. Participants reported itching sensations during 40% of tDCS sessions, with reports extinguishing within minutes after cessation of tDCS. The Fugl‐Meyer Assessment of the Upper Extremity is a functional scale with a score range of 0 (profound hemiplegia) to 66 (no impairment). An improvement of 5 points may be considered clinically significant. The median score was