Repetitive transcranial magnetic stimulation at 1Hz and 5Hz produces sustained improvement in motor function and disability after ischaemic stroke

Eur J Neurol. 2010 Sep;17(9):1203-9. doi: 10.1111/j.1468-1331.2010.03000.x. Epub 2010 Apr 8.

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) is a simple and non-invasive method of augmenting motor recovery after stroke, probably mediated by restoring inter-hemispheric activation balance. This placebo-controlled pilot study examined the possible benefit of stimulating the lesioned hemisphere (5-Hz rTMS) or inhibiting the contra-lesional hemisphere (1-Hz rTMS) on clinical recovery of motor function in patients with ischaemic stroke and assessed the sustainability of the response.

Methods: Sixty patients with ischaemic stroke (>1 month from onset) with mild-to-moderate hemiparesis were randomized to receive 10 daily sessions of either sham rTMS, 5-Hz ipsi-lesional rTMS or 1-Hz contra-lesional rTMS, in addition to a standard physical therapy protocol. Serial assessments were made over a period of 12 weeks by the thumb-index finger tapping test (FT), Activity Index (AI) score and the modified Rankin Scale (mRS).

Results: In contrast to control patients, those receiving active rTMS as ipsi-lesional 5-Hz stimulation or 1-Hz contra-lesional stimulation showed statistically significant improvement on the FT test, AI scores and mRS score at 2 weeks, and the effect was sustained over the 12-week observation period. No significant adverse events were observed during treatment in either group.

Conclusions: Repetitive TMS has beneficial effects on motor recovery that can be translated to clinically meaningful improvement in disability in patients with post-stroke hemiparesis, with a well-sustained effect. The similarity of inhibitory and stimulatory rTMS in producing these effects supports the inter-hemispheric balance hypothesis and encourages further research into their use in long-term neurorehabilitation programmes of patients with stroke.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Brain Ischemia / physiopathology*
  • Brain Ischemia / therapy*
  • Disability Evaluation*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Movement / physiology
  • Paresis / etiology
  • Paresis / physiopathology
  • Paresis / therapy
  • Placebos
  • Recovery of Function / physiology*
  • Stroke / physiopathology*
  • Stroke / therapy*
  • Time
  • Transcranial Magnetic Stimulation / methods*
  • Treatment Outcome

Substances

  • Placebos