{"doi":"10.1016/j.brs.2020.03.007","title":"Safety of single-pulse TMS in two infants with implanted patent ductus arteriosus closure devices","abstract":"Perinatal brain injuries (PBI) commonly occur in preterm infants, and can be a direct result of patent ductus arteriosus (PDA) wherein the blood vessel allowing flow between the aorta and pulmonary artery fails to close after birth [[1]Novak C.M. Ozen M. Burd I. Perinatal brain injury: mechanisms, prevention, and outcomes.Clin Perinatol. 2018; 45: 357-375Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar,[2]Slaughter J.L. Cua C.L. Notestine J.L. Rivera B.K. Marzec L. Hade E.M. et al.Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation.BMC Pediatr. 2019; 19: 333Crossref PubMed Google Scholar] Approximately 70% of preterm infants are diagnosed with PDA. Historically, the diagnosis of PDA has required surgical operative closure, but recently, to avoid thoracotomies, transcatheter implanted devices such as an occluder, coil, or clip have been increasingly integrated. Transcranial magnetic stimulation assessment of cortical excitability and neurophysiology can provide information regarding resultant cortical development and circuitry after PBI. Five known reports support the safety of single pulse TMS (SP-TMS) assessments in typically-developing infants and infants with impairments [3Eyre J.A. Smith M. Dabydeen L. Clowry G.J. Petacchi E. Battini R. et al.Is hemiplegic cerebral palsy equivalent to amblyopia of the corticospinal system?.Ann Neurol. 2007; 62: 493-503Crossref PubMed Scopus (202) Google Scholar, 4Narayana S. Mudigoudar B. Babajani-Feremi A. Choudhri A.F. Boop F.A. Successful motor mapping with transcranial magnetic stimulation in an infant: a case report.Neurology. 2017; 89: 2115-2117Crossref PubMed Scopus (9) Google Scholar, 5Colon A.J. Vredeveld J.W. Blaauw G. Motor evoked potentials after transcranial magnetic stimulation support hypothesis of coexisting central mechanism in obstetric brachial palsy.J Clin Neurophysiol. 2007; 24: 48-51Crossref PubMed Scopus (14) Google Scholar, 6Nemanich S.T. Chen C.Y. Chen M. Zorn E. Mueller B. Peyton C. et al.Safety and feasibility of transcranial magnetic stimulation as an exploratory assessment of corticospinal connectivity in infants after perinatal brain injury: an observational study.Phys Ther. 2019; 99: 689-700Crossref PubMed Scopus (8) Google Scholar, 7Kowalski J.L. Nemanich S.T. Nawshin T. Chen M. Peyton C. Zorn E. et al.Motor evoked potentials as potential biomarkers of early atypical corticospinal tract development in infants with perinatal stroke.J Clin Med. 2019; 8Crossref Scopus (12) Google Scholar]. No known reports exist surrounding the safety of SP-TMS in infants with PBI and implanted devices for PDA closure. Determination of the safety of SP-TMS with PDA closure devices is therefore indicated for assessment of this large proportion of preterm infants with PBI. As part of a pilot study utilizing SP-TMS to investigate neurodevelopment after PBI, two preterm infants with PDA closure devices were identified as meeting study inclusion criteria [[6]Nemanich S.T. Chen C.Y. Chen M. Zorn E. Mueller B. Peyton C. et al.Safety and feasibility of transcranial magnetic stimulation as an exploratory assessment of corticospinal connectivity in infants after perinatal brain injury: an observational study.Phys Ther. 2019; 99: 689-700Crossref PubMed Scopus (8) Google Scholar,[7]Kowalski J.L. Nemanich S.T. Nawshin T. Chen M. Peyton C. Zorn E. et al.Motor evoked potentials as potential biomarkers of early atypical corticospinal tract development in infants with perinatal stroke.J Clin Med. 2019; 8Crossref Scopus (12) Google Scholar]. This pilot incorporated SP-TMS assessment up to 100% of maximum stimulator output (MSO) using a Magstim Bistim2 and 2002 unit set and 70 mm figure-of-eight coil (Magstim Co. Ltd., Carmanthenshire, UK, peak magnetic field strength: 1.5 T, average inductance: 15.5 μH) [[8]Magstim 2nd generation coils operating manual. 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