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Expert consensus-based clinical roadmap for non-invasive brain stimulation in children and adolescents with cerebral palsy.

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Title: Expert consensus-based clinical roadmap for non-invasive brain stimulation in children and adolescents with cerebral palsy.
Authors: Goulardins JB; Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil; Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN Network), Brazil. Electronic address: julianagoulardins@bahiana.edu.br., Marques JB; Neurologic Rehabilitation Clinic, São Paulo, SP, Brazil., da Silveira Santos Machado B; Universidade Luterana do, Brazil, Canoas, RS., de Amorim SC; Ambulatório de Bloqueio Neuromuscular com Toxina Botulínica em crianças com sequelas neurológicas, do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: Simone.amorim@vitaclinica.com.br., Baptista AF; Centro Universitário Augusto Motta; Rio de Janeiro, RJ, Brazil., Carrara-Angelis E; A.C.Camargo Cancer Center, Sao Paulo, SP, Brazil. Electronic address: elisabete.carrara@accamargo.org.br., Shirahige L; Instituto de Neurociência Aplicada; Recife, PE, Brazil., Monte-Silva K; Universidade Federal de Pernambuco; Recife, PE, Brazil. Electronic address: monte.silva@ufpe.br.
Source: Brain & development [Brain Dev] 2026 Oct; Vol. 48 (5), pp. 104586. Date of Electronic Publication: 2026 Aug 19.
Publication Type: Journal Article; Review; Consensus Statement
Language: English
Journal Info: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 7909235 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-7131 (Electronic) Linking ISSN: 03877604 NLM ISO Abbreviation: Brain Dev Subsets: MEDLINE
Imprint Name(s): Publication: 1993- : Amsterdam : Elsevier
Original Publication: Tokyo, B & D Publishing Society.
MeSH Terms: Cerebral Palsy*/therapy , Cerebral Palsy*/physiopathology , Transcranial Magnetic Stimulation*/methods , Transcranial Direct Current Stimulation*/methods, Brain/physiopathology ; Humans ; Child ; Adolescent ; Consensus
Abstract: Aim: To develop an expert consensus-based clinical roadmap, informed by a structured review of current evidence, to support clinical reasoning regarding the application of non-invasive brain stimulation (NIBS) in children and adolescents with cerebral palsy (CP).
Method: A structured review of the literature was conducted to identify evidence regarding the use of NIBS in paediatric CP, prioritising meta-analyses, systematic reviews, and randomized controlled trials. Evidence related to stimulation targets, protocol characteristics, motor outcomes, and safety considerations was synthesised to inform the development of a preliminary clinical roadmap. The roadmap subsequently underwent refinement through a modified Delphi process involving clinicians and researchers with expertise in paediatric neurorehabilitation and neuromodulation. The Delphi process focused on evaluating the clinical applicability, feasibility, and usability of the proposed framework.
Results: The final roadmap integrates current evidence with multidisciplinary expert consensus to support individualized clinical decision-making across motor domains and CP clinical presentations. Current evidence most consistently supports the consideration of NIBS as an adjunct to active rehabilitation for locomotor function in spastic diplegia and upper-limb function in spastic hemiplegia. Evidence for quadriplegia, ataxia, and dystonia remains limited and should be interpreted cautiously. The roadmap also incorporates expert consensus regarding safety considerations, clinical implementation, and outcome monitoring.
Interpretation: This expert consensus-based roadmap provides a structured framework to support individualized and goal-oriented clinical decision-making regarding NIBS in paediatric CP. It is intended to facilitate the translation of heterogeneous evidence into clinical practice and should not be interpreted as a clinical guideline or formal recommendation document.
(Copyright © 2026. Published by Elsevier B.V.)
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Some authors are members of the Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN Network), a non-profit scientific and educational association dedicated to research, clinical practice, and professional training in non-invasive neuromodulation. The NAPeN Network promotes educational and professional training courses in neuromodulation; however, it has no financial, manufacturing, licensing, or distribution interests related to neuromodulation devices or technologies. No funding, sponsorship, or material support from device manufacturers or other commercial entities was received for the development of this study. These educational activities did not influence the study design, evidence synthesis, roadmap development, expert consensus process, or conclusions. The remaining authors declare that they have no competing interests.
Contributed Indexing: Keywords: Cerebral palsy; Delphi technique; Expert consensus; Non-invasive brain stimulation; Repetitive transcranial magnetic stimulation; Transcranial direct current stimulation
Entry Date(s): Date Created: 20260819 Date Completed: 20260906 Latest Revision: 20260914
Update Code: 20260914
DOI: 10.1016/j.braindev.2026.104586
PMID: 42617206
Database: MEDLINE
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  Data: Expert consensus-based clinical roadmap for non-invasive brain stimulation in children and adolescents with cerebral palsy.
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  Data: <searchLink fieldCode="AU" term="%22Goulardins+JB%22">Goulardins JB</searchLink>; Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil; Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN Network), Brazil. Electronic address: julianagoulardins@bahiana.edu.br.<br /><searchLink fieldCode="AU" term="%22Marques+JB%22">Marques JB</searchLink>; Neurologic Rehabilitation Clinic, São Paulo, SP, Brazil.<br /><searchLink fieldCode="AU" term="%22da+Silveira+Santos+Machado+B%22">da Silveira Santos Machado B</searchLink>; Universidade Luterana do, Brazil, Canoas, RS.<br /><searchLink fieldCode="AU" term="%22de+Amorim+SC%22">de Amorim SC</searchLink>; Ambulatório de Bloqueio Neuromuscular com Toxina Botulínica em crianças com sequelas neurológicas, do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: Simone.amorim@vitaclinica.com.br.<br /><searchLink fieldCode="AU" term="%22Baptista+AF%22">Baptista AF</searchLink>; Centro Universitário Augusto Motta; Rio de Janeiro, RJ, Brazil.<br /><searchLink fieldCode="AU" term="%22Carrara-Angelis+E%22">Carrara-Angelis E</searchLink>; A.C.Camargo Cancer Center, Sao Paulo, SP, Brazil. Electronic address: elisabete.carrara@accamargo.org.br.<br /><searchLink fieldCode="AU" term="%22Shirahige+L%22">Shirahige L</searchLink>; Instituto de Neurociência Aplicada; Recife, PE, Brazil.<br /><searchLink fieldCode="AU" term="%22Monte-Silva+K%22">Monte-Silva K</searchLink>; Universidade Federal de Pernambuco; Recife, PE, Brazil. Electronic address: monte.silva@ufpe.br.
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  Data: <searchLink fieldCode="JN" term="%227909235%22">Brain & development</searchLink> [Brain Dev] 2026 Oct; Vol. 48 (5), pp. 104586. <i>Date of Electronic Publication: </i>2026 Aug 19.
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  Data: Journal Article; Review; Consensus Statement
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Elsevier%22">Elsevier </searchLink><i>Country of Publication: </i>Netherlands <i>NLM ID: </i>7909235 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>1872-7131 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2203877604%22">03877604 </searchLink><i>NLM ISO Abbreviation: </i>Brain Dev <i>Subsets: </i>MEDLINE
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  Data: <searchLink fieldCode="MM" term="%22Cerebral+Palsy%22">Cerebral Palsy*</searchLink>/<searchLink fieldCode="MM" term="%22Cerebral+Palsy+therapy%22">therapy</searchLink> <br /><searchLink fieldCode="MM" term="%22Cerebral+Palsy%22">Cerebral Palsy*</searchLink>/<searchLink fieldCode="MM" term="%22Cerebral+Palsy+physiopathology%22">physiopathology</searchLink> <br /><searchLink fieldCode="MM" term="%22Transcranial+Magnetic+Stimulation%22">Transcranial Magnetic Stimulation*</searchLink>/<searchLink fieldCode="MM" term="%22Transcranial+Magnetic+Stimulation+methods%22">methods</searchLink> <br /><searchLink fieldCode="MM" term="%22Transcranial+Direct+Current+Stimulation%22">Transcranial Direct Current Stimulation*</searchLink>/<searchLink fieldCode="MM" term="%22Transcranial+Direct+Current+Stimulation+methods%22">methods</searchLink><br /><searchLink fieldCode="MH" term="%22Brain%22">Brain</searchLink>/<searchLink fieldCode="MH" term="%22Brain+physiopathology%22">physiopathology</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Child%22">Child</searchLink> ; <searchLink fieldCode="MH" term="%22Adolescent%22">Adolescent</searchLink> ; <searchLink fieldCode="MH" term="%22Consensus%22">Consensus</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Aim: To develop an expert consensus-based clinical roadmap, informed by a structured review of current evidence, to support clinical reasoning regarding the application of non-invasive brain stimulation (NIBS) in children and adolescents with cerebral palsy (CP).<br />Method: A structured review of the literature was conducted to identify evidence regarding the use of NIBS in paediatric CP, prioritising meta-analyses, systematic reviews, and randomized controlled trials. Evidence related to stimulation targets, protocol characteristics, motor outcomes, and safety considerations was synthesised to inform the development of a preliminary clinical roadmap. The roadmap subsequently underwent refinement through a modified Delphi process involving clinicians and researchers with expertise in paediatric neurorehabilitation and neuromodulation. The Delphi process focused on evaluating the clinical applicability, feasibility, and usability of the proposed framework.<br />Results: The final roadmap integrates current evidence with multidisciplinary expert consensus to support individualized clinical decision-making across motor domains and CP clinical presentations. Current evidence most consistently supports the consideration of NIBS as an adjunct to active rehabilitation for locomotor function in spastic diplegia and upper-limb function in spastic hemiplegia. Evidence for quadriplegia, ataxia, and dystonia remains limited and should be interpreted cautiously. The roadmap also incorporates expert consensus regarding safety considerations, clinical implementation, and outcome monitoring.<br />Interpretation: This expert consensus-based roadmap provides a structured framework to support individualized and goal-oriented clinical decision-making regarding NIBS in paediatric CP. It is intended to facilitate the translation of heterogeneous evidence into clinical practice and should not be interpreted as a clinical guideline or formal recommendation document.<br /> (Copyright © 2026. Published by Elsevier B.V.)
– Name: Abstract
  Label: Competing Interests
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  Data: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Some authors are members of the Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN Network), a non-profit scientific and educational association dedicated to research, clinical practice, and professional training in non-invasive neuromodulation. The NAPeN Network promotes educational and professional training courses in neuromodulation; however, it has no financial, manufacturing, licensing, or distribution interests related to neuromodulation devices or technologies. No funding, sponsorship, or material support from device manufacturers or other commercial entities was received for the development of this study. These educational activities did not influence the study design, evidence synthesis, roadmap development, expert consensus process, or conclusions. The remaining authors declare that they have no competing interests.
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