BACKGROUND:Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the contralesional primary motor cortex (M1) may improve recovery in patients with hemiparetic stroke. OBJECTIVE: To evaluate the effectiveness of applying 1 Hz rTMS to the contralesional M1 in addition to physiotherapy during early rehabilitation for stroke patients with hand hemiparesis in a randomized, sham-controlled, double-blind study. METHODS:Forty patients with moderate upper extremity hemiparesis were randomized to receive 3 weeks of motor training (45 minutes daily) preceded by 30 minutes of 1 Hz rTMS applied to the contralesional M1 or 30 minutes of sham rTMS. Functional assessment of the paretic hand using the Wolf Motor Function Test was performed before, immediately after, and 3 months after completing treatment. RESULTS: No statistically significant differences were found between the experimental and the control group for hand function (Wolf Motor Function Test; P = .92) or the level of neurological deficit (National Institutes of Health Stroke Scale [NIHSS]; P = .82) after treatment. Effect sizes for the experimental (d = 0.5) and the control group (d = 0.47) were small. Similar results were observed at the 3-month follow-up. CONCLUSIONS: The findings did not suggest that rTMS suppression of the contralesional motor cortex augments the effect of early neurorehabilitation for upper limb hemiparesis. Larger trials that stratify subjects based on residual motor function or physiological measures of excitation and inhibition may identify responders in the future.
RCT Entities:
BACKGROUND: Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the contralesional primary motor cortex (M1) may improve recovery in patients with hemiparetic stroke. OBJECTIVE: To evaluate the effectiveness of applying 1 Hz rTMS to the contralesional M1 in addition to physiotherapy during early rehabilitation for strokepatients with hand hemiparesis in a randomized, sham-controlled, double-blind study. METHODS: Forty patients with moderate upper extremity hemiparesis were randomized to receive 3 weeks of motor training (45 minutes daily) preceded by 30 minutes of 1 Hz rTMS applied to the contralesional M1 or 30 minutes of sham rTMS. Functional assessment of the paretic hand using the Wolf Motor Function Test was performed before, immediately after, and 3 months after completing treatment. RESULTS: No statistically significant differences were found between the experimental and the control group for hand function (Wolf Motor Function Test; P = .92) or the level of neurological deficit (National Institutes of Health Stroke Scale [NIHSS]; P = .82) after treatment. Effect sizes for the experimental (d = 0.5) and the control group (d = 0.47) were small. Similar results were observed at the 3-month follow-up. CONCLUSIONS: The findings did not suggest that rTMS suppression of the contralesional motor cortex augments the effect of early neurorehabilitation for upper limb hemiparesis. Larger trials that stratify subjects based on residual motor function or physiological measures of excitation and inhibition may identify responders in the future.
Authors: James R Carey; Huiqiong Deng; Bernadette T Gillick; Jessica M Cassidy; David C Anderson; Lei Zhang; William Thomas Journal: Restor Neurol Neurosci Date: 2014 Impact factor: 2.406
Authors: David A Cunningham; Nicole Varnerin; Andre Machado; Corin Bonnett; Daniel Janini; Sarah Roelle; Kelsey Potter-Baker; Vishwanath Sankarasubramanian; Xiaofeng Wang; Guang Yue; Ela B Plow Journal: Restor Neurol Neurosci Date: 2015 Impact factor: 2.406
Authors: Giovanni Di Pino; Giovanni Pellegrino; Giovanni Assenza; Fioravante Capone; Florinda Ferreri; Domenico Formica; Federico Ranieri; Mario Tombini; Ulf Ziemann; John C Rothwell; Vincenzo Di Lazzaro Journal: Nat Rev Neurol Date: 2014-09-09 Impact factor: 42.937