Applications of non-invasive brain stimulation in the treatment of children with cerebral palsy: a narrative review

Noninvasive brain stimulation has emerged as a promising adjunctive strategy for pediatric neurorehabilitation, particularly for children with cerebral palsy. This narrative review, informed by a structured literature search, summarizes current evidence on transcranial direct current stimulation and repetitive transcranial magnetic stimulation in children with cerebral palsy, with emphasis on neurophysiological mechanisms, brain network targets, clinical outcomes, safety, and future translational directions. Cerebral palsy is a heterogeneous neurodevelopmental condition characterized by persistent motor impairment and frequent sensory, cognitive, communicative, behavioral, and musculoskeletal comorbidities. Although multidisciplinary rehabilitation remains the foundation of clinical management, improvements in higher level motor control, cognition, communication, and real world participation are often constrained by training intensity, adherence, developmental heterogeneity, and resource availability. Neuroimaging and electrophysiological studies indicate that children with cerebral palsy may present with corticospinal tract impairment, altered cerebellar thalamic cortical circuitry, interhemispheric inhibitory imbalance, and atypical development of frontoparietal executive control and language related networks. These findings provide a rationale for targeting the primary motor cortex, dorsolateral prefrontal cortex, and selected language related cortices with neuromodulatory interventions. At the mechanistic level, transcranial direct current stimulation and repetitive transcranial magnetic stimulation may influence cortical excitability, NMDA receptor mediated long term potentiation and long term depression like plasticity, interhemispheric inhibition, and functional connectivity within distributed neural networks. Current evidence from small to moderate sized randomized trials and recent systematic reviews suggests that these techniques, when combined with task specific rehabilitation, may provide additional benefits for gross motor function, gait, balance, upper limb dexterity, spasticity, and selected cognitive, dual task, and communication outcomes. Available data also suggest acceptable short term safety and tolerability when appropriate pediatric screening and recommended stimulation parameters are applied. This review summarizes the current research progress on noninvasive brain stimulation in children with cerebral palsy and highlights its potential value for optimizing individualized neurorehabilitation strategies and improving motor, cognitive, and communication related outcomes.