To evaluate safety and efficacy of repetitive transcranial magnetic stimulation (rTMS) as adjunct to modified constraint-induced movement therapy (mCIMT) in improving upper limb function in children with unilateral cerebral palsy (CP).

It is crucial to devise optimum rehabilitation programs for children with cerebral palsy (CP).

In this single-centre, double blinded, randomized controlled trial, 46 children (5-15 years) were randomized (using block randomization, 23 in each arm) to receive mCIMT with rTMS (intervention arm) or mCIMT with sham rTMS (control arm). The primary outcome was mean change in Quality of Upper Extremity Skills Test (QUEST) scores at the end of 4 weeks of therapy. Secondary outcomes were changes in QUEST domain-scores, speed (measured by 9-hole peg board), and strength (measured by dynamometry) parameters of upper limb and CP quality of life (CP-QOL) scores.

All children (30 males) except one completed the trial.The mean change in total QUEST score at 4 weeks, was significantly higher in intervention arm as compared to control arm (11.66 + 6.97 vs 6.56 + 4.3, d=5.1, 95% CI 1.7 – 8.5, p = 0.004). 82.6% children had increase in total QUEST score by > 5 in intervention arm as compared to 52.2% in control arm (p=0.027) at 4 weeks. Change in  ‘weight  bearing’  and  ‘protective extension’  domain score was significantly higher for children in the intervention arm. The improvement in speed and strength scores of upper limb of intervention arm was higher than the control arm but was not found to be statistically significant. Significant difference in CP-QOL domain scores (feelings about functioning and participation and physical health) was found at 12 weeks. No serious adverse events were seen.