repetitive transcranial magnetic stimulation versus botulinum injection on spasticity on children with diplegic cerebral palsy

Conditions: Spastic Diplegic Cerebral Palsy

Summary: this trial will enroll 75 children with spastic diplegic cerebral palsy both matched in age, sex, degree of disability and cognitive functions with the same exclusion criteria undergoing the same physical therapy. all enrolled children will undergo routine physical therapy program and will be divided into three groups (n = 25 per group) according treatment methods. group a: children will be given local injections of botulinum toxin type ,group b: children will be given repetitive transcranial magnetic stimulation on the affected side; group c: children will be given local injections of botulinum toxin type a combined with repetitive transcranial magnetic stimulation , the three groups will take physical therapy (pt) of 45 minutes duration 4 days a week for 3 months .the grade of spasticity will be assessed by using modified ashworth scale and m/h ratio by using emg. the grade of motor function will assessed by using gross motor function classification system (gmfcs).

this trial will enrol 75 children with spastic diaplegic cerebral palsy with both sex, degree of disability and cognitive functions with the same exclusion criteria and the same physical therapy program. all enrolled children will undergo routine physical therapy program and will be divided into three groups (n = 25 per group) according treatment methods. group a: children will be given local injections of botulinum toxin type ,group b: children will be given repetitive transcranial magnetic stimulation on the affected side; group c: children will be given local injections of botulinum toxin type a combined with repetitive transcranial magnetic stimulation , the three groups will take physical therapy (pt) of 45 minutes duration 4 days a week for 3 months. they will diagnosed based on history taking including perinatal, developmental, and family history, general and neurological examination. the included children with clinical diagnosis of moderate spastic diplegic cerebral palsy with a mas (1, 1+, 2) and gmfcs (ii, iii, iv) will participated in this study. on the contrary, children with dyskinetic cp, mental retardation, previous ankle or knee surgery, uncontrolled epileptic seizure or contracture will excluded

Eligibility criteria:
inclusion criteria: * were diagnosed based on history taking including perinatal, developmental, and family history, general and neurological examination. the included children with clinical diagnosis of moderate spastic dialogic cerebral palsy with a mas (1, 1+, 2) and gmfcs (ii, iii, iv) were participated in this study exclusion criteria: children who's contraindicated to rtms treatment have metal implants such as internal pacemakers and intracranial scaffolds, and/or a history of epilepsy. * children who's contraindicated for btx-a treatment: hypersensitivity and local infection at the injection site. * children which have received a local injection of btx-a within 3 months. * children with dyskinetic cp, * mental retardation, * previous, seizure or contracture were excluded.