Non-invasive brain stimulation for motor rehabilitation in pediatric stroke: a scoping review

Introduction Pediatric stroke is a leading cause of neurological disability, often resulting in hemiparetic cerebral palsy (HCP). Non-invasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), may enhance motor recovery due to the developing brain's neuroplasticity. Objectives To map the available evidence on the feasibility, safety, and clinical and neurophysiological outcomes of rTMS and tDCS in children and adolescents with hemiparesis secondary to pediatric stroke. Methods A scoping review of 11 publications representing 8 independent controlled trials published between 2005 and 2025: 4 rTMS trials (6 reports) and 4 tDCS trials (5 reports) involving perinatal or pediatric stroke. Additional reports from the same cohorts were retained when assessing different outcomes or follow-up points but were not counted as independent cohorts. Clinical, neurophysiological, and safety outcomes were synthesized descriptively. Results NIBS was feasible and generally well tolerated under the studied protocols, with no serious treatment-related adverse events. Some small rTMS trials reported benefits in selected upper-limb outcomes compared with sham, but effect magnitude and durability remain uncertain. Smaller tDCS trials yielded mixed findings, including improved subjective occupational performance without additional gains in objectively assessed hand function. The largest multicenter trial, involving 89 randomized children with perinatal stroke and unilateral cerebral palsy, found no additional benefit over sham in hand function or achievement of child-identified functional goals. One small rTMS trial included 10 participants with childhood-onset arterial ischemic stroke; no controlled tDCS trial specifically targeting childhood-onset stroke was identified. Discussion NIBS appears feasible and generally well tolerated in children with stroke-related hemiparesis. Upper-limb motor recovery benefits have been reported, particularly alongside intensive rehabilitation, although the largest pediatric tDCS trial showed no additional motor benefit. Corticospinal and metabolic predictors remain exploratory. The small evidence base, methodological heterogeneity, and interindividual variability preclude definitive conclusions about clinical effectiveness. Evidence predominantly concerns perinatal stroke and unilateral cerebral palsy, limiting generalizability to childhood-onset stroke. Future research should standardize protocols and investigate whether individualized approaches incorporating neuroimaging and neurophysiological biomarkers improve rehabilitation outcomes.