Abstract 032: TOPSS: TOlerability of tDCS in Pediatric Stroke Survivors
Authors: Fraser S. M. , Clearman A. , Abrahams M. , Gillick B. , Lal T. , Savitz S. , Yozbatiran N. 
Published: January 2025

Introduction
Pediatric 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.

Methods
Participants 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.

Results
Five 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 35 at the pre‐therapy assessment, and improved to 42 at the 3 month follow up. 4 out of 5 participants had a clinically significant increase in the Fugl‐Meyer Assessment. Canadian Occupational Performance Measure performance score was 4 at baseline and improved to 6.4 at 3 month follow up.

Conclusion
tDCS was well‐tolerated in this pilot study of tDCS in participants with chronic hemiparesis from childhood‐onset stroke. There were no major adverse events, and the most common reported side effects were mild itching or tingling which did not limit participation. Fugl‐Meyer Assessment of the Upper Extremity scores improved an average of 7 points 3 months post therapy. Further research with larger, double‐blinded, sham controlled studies is needed. We will continue further research into the utility of tDCS for childhood‐onset stroke with a single center, double‐blinded, randomized controlled trial of tDCS vs sham with a goal enrollment of 20 participants.