Repetitive Transcranial Magnetic Stimulation of Contralesional Primary Motor Cortex Improves Hand Function After Stroke
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Status:
Complete. Published December 2005.
Purpose:
To determine whether a decreased excitability of the contralesional motor cortex (M1) induced by 1 Hz repetitive transcranial magnetic stimulation (rTMS) caused an improved motor performance of the affected hand in stroke patients by releasing the transcallosal inhibition (TCI).
Interventions:
Magnetic Stimulation
A procedure where a pulse magnetic field (generated by passing brief current pulses through a figure 8 coil of wire that is encased in plastic) is held close to the scalp so that the magnetic field can be focused onto specific areas of the cortex of the brain. The field can penetrate the scalp and skull safely to induce a current in specific neurons and is delivered at regular intervals. Painless, non-invasive and outpatient therapy approved for use in Canada that does not require anaesthesia.
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Design:
Randomized, controlled, double-blind study.
Inclusion Criteria
Patients >/= 6 months after a first-time cerebral
infarct, confirmed by MRI; with a normal Mini-Mental State Examination score.
Patient Involvement:
After patients had wellperformed motor training to minimize the possibility of motor training during the motor measurement, they were randomly assigned to receive a subthreshold rTMS at the contralesional M1 (1 Hz, 25 minutes) or sham stimulation.
Primary Outcome:
Maximum pinch force of the affected hand was determined using a pinch gauge (Pinch Meter SPR-641; Sakai Medical), and movement acceleration was measured with a monoaxial accelerometer (model MP110-10-101, Medisens) which was firmly fixed to the dorsal side of the proximal phalanx of the thumb with a tape.
Results:
Compared with sham stimulation, rTMS reduced the amplitude of motor-evoked potentials in contralesional M1 and the TCI duration (amplitude, P<0.01; TCI duration, P<0.01), and rTMS immediately induced an improvement in pinch acceleration of the affected hand (rTMS group: pinch force, P<0.05; acceleration, P<0.01; sham group: pinch force, P<0.01; acceleration, P<0.05), although a plateau in motor performance had been reached by the previous motor training. This improvement in motor function after rTMS was significantly correlated with a reduced TCI duration (r=0.89, P<0.01).
Source of Information:
Stroke. 2005;36:2681-2686.
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This information last updated on: 1/3/2006
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