To evaluate the efficacy and safety of noninvasive brain stimulation (NIBS) in children with hemiparesis secondary to perinatal stroke.

Perinatal stroke is a leading cause of childhood hemiparesis, resulting in persistent motor deficits affecting quality of life. Noninvasive brain stimulation (NIBS), including transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), has emerged as a potential adjunct to motor therapy enhancing cortical excitability and promoting neuroplasticity.

We searched PubMed, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov up to August 2025 for RCTs focusing noninvasive brain stimulation (tDCS or rTMS) adjunctive to Motor Therapy in children with perinatal stroke hemiparesis. Four RCTs (105 participants) were included. Primary outcomes were Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM). Secondary outcomes included Melbourne Assessment (MA), Box and Block Test (BBT), Pediatric Quality of Life (PedsQL), and mild tingling or itching. Random-effects models calculated pooled mean differences (MDs) and risk ratios (RRs).

Pooled analyses showed insignificant improvement in AHA scores at 6 months (MD = 0.41, 95% CI: –2.44 to 3.26, p = 0.78), but revealed a significant increase in COPM performance scores favoring NIBS (MD = 0.83, 95% CI: 0.14 to 1.53, p = 0.02). Improvements seen in MA and PedsQL but statistically insignificant. Safety analyses showed that there was no decline in unaffected hand function (MD = -0.26, 95% CI: -3.09 to 2.57, p = 0.86). Mild adverse effects, such as itching, were similar between groups (RR = 1.00, 95% CI: 0.56 to 1.79, p = 0.99).

Adjunctive NIBS with intensive motor therapy appears safe and may modestly improve perceived functional performance among children with perinatal stroke hemiparesis, though evidence for objective motor gains remains inconclusive. Larger, well-controlled studies are warranted to optimize protocols and confirm clinical benefit.