Koichi Hosomi1, Shayne Morris2, Tomosaburo Sakamoto3, Junji Taguchi4, Tomoyuki Maruo1, Yu Kageyama2, Yusuke Kinoshita4, Yuko Goto1, Toshio Shimokawa5, Tetsuo Koyama6, Youichi Saitoh7. 1. Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan. 2. Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan. 3. Kansai Rehabilitation Hospital, Osaka, Japan. 4. Takarazuka Rehabilitation Hospital, Hyogo, Japan. 5. Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan. 6. Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan. 7. Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: neurosaitoh@mbk.nifty.com.
Abstract
BACKGROUND: We conducted a randomized, double-blind, sham-controlled study to assess the efficacy in motor recovery and safety of daily repetitive transcranial magnetic stimulation (rTMS) in subacute stroke patients. METHODS:Forty-one patients were randomly assigned to a real or sham stimulation group. Each patient underwent regular rehabilitation accompanied by a series of 10 daily 5-Hz rTMS of the ipsilesional primary motor cortex (M1) or sham stimulation. The primary outcome was motor recovery evaluated by the Brunnstrom stages (BS). The secondary outcomes were improvement in the Fugl-Meyer Assessment (FMA), grip power, National Institutes of Health Stroke Scale (NIHSS), Functional Independence Measure (FIM), a quantitative measurement of finger tapping movement, and the incidence of adverse events. RESULTS:Thirty-nine patients completed the study and were included in the analyses. The real rTMS group demonstrated additional improvement in the BS hand score at the last follow-up compared to the sham. The grip power, the NIHSS motor score, and the number of finger taps in the affected hand improved in the real stimulation group but not in the sham group. The BS upper limb scores, the FMA distal upper limb score, the NIHSS total score, and the FIM motor score showed improvement from baseline at the earlier time points after the real rTMS. There were no additional improvements in the other scores after the real rTMS compared to the sham. No serious adverse events were observed. CONCLUSIONS: Our results suggest that dailyhigh-frequency rTMS of the ipsilesional M1 is tolerable and modestly facilitates motor recovery in the paralytic hand of subacute stroke patients.
RCT Entities:
BACKGROUND: We conducted a randomized, double-blind, sham-controlled study to assess the efficacy in motor recovery and safety of daily repetitive transcranial magnetic stimulation (rTMS) in subacute strokepatients. METHODS: Forty-one patients were randomly assigned to a real or sham stimulation group. Each patient underwent regular rehabilitation accompanied by a series of 10 daily 5-Hz rTMS of the ipsilesional primary motor cortex (M1) or sham stimulation. The primary outcome was motor recovery evaluated by the Brunnstrom stages (BS). The secondary outcomes were improvement in the Fugl-Meyer Assessment (FMA), grip power, National Institutes of Health Stroke Scale (NIHSS), Functional Independence Measure (FIM), a quantitative measurement of finger tapping movement, and the incidence of adverse events. RESULTS: Thirty-nine patients completed the study and were included in the analyses. The real rTMS group demonstrated additional improvement in the BS hand score at the last follow-up compared to the sham. The grip power, the NIHSS motor score, and the number of finger taps in the affected hand improved in the real stimulation group but not in the sham group. The BS upper limb scores, the FMA distal upper limb score, the NIHSS total score, and the FIM motor score showed improvement from baseline at the earlier time points after the real rTMS. There were no additional improvements in the other scores after the real rTMS compared to the sham. No serious adverse events were observed. CONCLUSIONS: Our results suggest that dailyhigh-frequency rTMS of the ipsilesional M1 is tolerable and modestly facilitates motor recovery in the paralytic hand of subacute strokepatients.
Authors: David Beckwée; Lotte Cuypers; Nina Lefeber; Emma De Keersmaecker; Ellen Scheys; Wout Van Hees; Stany Perkisas; Sylvie De Raedt; Eric Kerckhofs; Ivan Bautmans; Eva Swinnen Journal: J Rehabil Med Date: 2022-10-04 Impact factor: 3.959
Authors: Eline C C van Lieshout; Johanna M A Visser-Meily; Sebastiaan F W Neggers; H Bart van der Worp; Rick M Dijkhuizen Journal: BMJ Open Date: 2017-08-28 Impact factor: 2.692