Abstract
Both inhibitory and excitatory ipsilesional and contralesional non-invasive brain stimulation protocols (rTMS, TBS) have been applied during the acute, postacute and chronic phases to improve motor recovery in stroke patients having upper and/or lower limb paresis. A best evidence synthesis based on RCTs and meta-analyses is presented that can be used for clinical decision making.
Taken together, there is a substantial database indicating that the above-mentioned rTMS applications are safe when the conventional safety recommendations are followed. The intervention that had best been investigated is contralesional M1 low-frequency (inhibitory) rTMS. The most focused meta-analysis reported to date documents an overall effect size of 0.55 on average for rTMS therapies in arm motor rehabilitation after stroke that can be considered moderate. Given the low risk profile and the demonstrated clinical benefits, there is reason to recommend and apply rTMS therapy in stroke patients with motor deficits, especially arm paresis.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Ackerley SJ, Stinear CM, Barber PA, Byblow WD (2010) Combining theta burst stimulation with training after subcortical stroke. Stroke 41:1568–1572
Adeyemo BO, Simis M, Macea DD, Fregni F (2012) Systematic review of parameters of stimulation, clinical trial design characteristics, and motor outcomes in noninvasive brain stimulation in stroke. Front Psychiatry 3:88
Andrews J, Guyatt G, Oxman AD, Alderson P, Dahm P, Falck-Ytter Y, Nasser M, Meerpohl J, Post PN, Kunz R, Brozek J, Vist G, Rind D, Akl EA, Schünemann HJ, GRADE guidelines: 15 (2013) Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol 66:719–725
Ayache SS, Farhat WH, Zouari HG, Hosseini H, Mylius V, Lefaucheur JP (2012) Stroke rehabilitation using noninvasive cortical stimulation: motor deficit. Expert Rev Neurother 12:949–972
Avenanti A, Coccia M, Ladavas E, Provinciali L, Ceravolo MG (2012) Low-frequency rtms promotes use-dependent motor plasticity in chronic stroke: a randomized trial. Neurology 78:256–264
Burneo JG, Fang J, Saposnik G (2010) Impact of seizures on morbidity and mortality after stroke: a Canadian multi-centre cohort study. Eur J Neurol 17:52–58
Chang WH, Kim YH, Bang OY, Kim ST, Park YH, Lee PK (2010) Long-term effects of rTMS on motor recovery in patients after subacute stroke. J Rehabil Med 42:758–764
Chang WH, Bang OY, Shin YI, Lee A, Pascual-Leone A, Kim YH (2014) BDNF polymorphism and differential rTMS effects on motor recovery of stroke patients. Brain Stimul 7:553–558
Chieffo R, De Prezzo S, Houdayer E, Nuara A, Di Maggio G, Coppi E, Ferrari L, Straffi L, Spagnolo F, Velikova S, Sessa M, Comola M, Zangen A, Comi G, Leocani L (2014) Deep repetitive transcranial magnetic stimulation with H-coil on lower limb motor function in chronic stroke: a pilot study. Arch Phys Med Rehabil 95:1141–1147
Conforto AB, Anjos SM, Saposnik G, Mello EA, Nagaya EM, Santos W Jr et al (2012) Transcranial magnetic stimulation in mild to severe hemiparesis early after stroke: a proof of principle and novel approach to improve motor function. J Neurol 259:1399–1405
Emara T, El Nahas N, Elkader HA, Ashour S, El Etrebi A (2009) MRI can predict the response to therapeutic repetitive transcranial magnetic stimulation (rTMS) in stroke patients. J Vasc Interv Neurol 2:163–168
Emara TH, Moustafa RR, Elnahas NM, Elganzoury AM, Abdo TA, Mohamed SA et al (2010) Repetitive transcranial magnetic stimulation at 1 Hz and 5 Hz produces sustained improvement in motor function and disability after ischaemic stroke. Eur J Neurol 17:1203–1209
Etoh S, Noma T, Ikeda K, Jonoshita Y, Ogata A, Matsumoto S et al (2013) Effects of repetitive trascranial magnetic stimulation on repetitive facilitation exercises of the hemiplegic hand in chronic stroke patients. J Rehabil Med 45:843–847
Feigin VL, Lawes CM, Bennett DA, Anderson CS (2003) Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2:43–53
Fregni F, Boggio PS, Valle AC, Rocha RR, Duarte J, Ferreira MJ et al (2006) A sham controlled trial of a 5-day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients. Stroke 37:2115–2122
Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schünemann HJ, GRADE Working Group (2008) Going from evidence to recommendations. BMJ 336:1049–1051
Hao Z, Wang D, Zeng Y, Liu M (2013) Repetitive transcranial magnetic stimulation for improving function after stroke. Cochrane Database Syst Rev (5):CD008862.
Hsu WY, Cheng CH, Liao KK, Lee IH, Lin YY (2012) Effects of repetitive transcranial magnetic stimulation on motor functions in patients with stroke: a metaanalysis. Stroke 43:1849–1857
Khedr EM, Abdel-Fadeil MR, Farghali A, Qaid M (2009) Role of 1 and 3 Hz repetitive transcranial magnetic stimulation on motor function recovery after acute ischaemic stroke. Eur J Neurol 16:1323–1330
Kim YH, You SH, Ko MH, Park JW, Lee KH, Jang SH et al (2006) Repetitive transcranial magnetic stimulation-induced corticomotor excitability and associated motor skill acquisition in chronic stroke. Stroke 37:1471–1476
Le Q, Qu Y, Tao Y, Zhu S (2014) Effects of repetitive transcranial magnetic stimulation on hand function recovery and excitability of the motor cortex after stroke: a meta-analysis. Am J Phys Med Rehabil 93:422–430
Levin MF, Kleim JA, Wolf SL (2009) What do motor “recovery” and “compensation” mean in patients following stroke? Neurorehabil Neural Repair 23:313–319
Liepert J, Zittel S, Weiller C (2007) Improvement of dexterity by single session low frequency repetitive transcranial magnetic stimulation over the contralesional motor cortex in acute stroke: a double-blind placebo-controlled crossover trial. Restor Neurol Neurosci 25:461–465
Lomarev MP, Kim DY, Richardson SP, Voller B, Hallett M (2007) Safety study of high-frequency transcranial magnetic stimulation in patients with chronic stroke. Clin Neurophysiol 118:2072–2075
Malcolm MP, Triggs WJ, Light KE, Gonzalez Rothi LJ, Wu S, Reid K et al (2007) Repetitive transcranial magnetic stimulation as an adjunct to constraint-induced therapy: an exploratory randomized controlled trial. Am J Phys Med Rehabil 86(9):707–715
Mansur CG, Fregni F, Boggio PS, Riberto M, Gallucci-Neto J et al (2005). A sham stimulation-controlled trial of rTMS of the unaffected hemisphere in stroke patients. Neurology 24;64(10):1802–1804
Meehan SK, Dao E, Linsdell MA, Boyd LA (2011) Continuous theta burst stimulation over the contralesional sensory and motor cortex enhances motor learning poststroke. Neurosci Lett 500:26–30
Platz T, Eickhof C, van Kaick S, Engel U, Pinkowski C, Kalok S, Pause M (2005) Impairment-oriented training or Bobath therapy for arm paresis after stroke: a single blind, multi-centre randomized controlled trial. Clin Rehabil 19:714–724
Platz T, Roschka S, Christel MI, Duecker F, Rothwell JC, Sack A (2012a) Early stages of motor skill learning and the specific relevance of the cortical motor system – a combined behavioural training and theta burst TMS study. Restor Neurol Neurosci 30:199–211
Platz T, Roschka S, Doppl K, Roth C, Lotze M, Sack AT, Rothwell JC (2012b) Prolonged motor skill learning – a combined behavioural training and theta burst TMS study. Restor Neurol Neurosci 30:213–224
Pomeroy VM, Cloud G, Tallis RC, Donaldson C, Nayak V, Miller S (2007) Transcranial magnetic stimulation and muscle contraction to enhance stroke recovery: a randomized proof-of-principle and feasibility investigation. Neurorehabil Neural Repair 21(6):509–517
Rossi S, Hallett M, Rossini PM, Pascual-Leone A, Safety of TMS Consensus Group (2009) Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 120:2008–2039
Sasaki N, Mizutani S, Kakuda W, Abo M (2013) Comparison of the effects of high- and low frequency repetitive transcranial magnetic stimulation on upper limb hemiparesis in the early phase of stroke. J Stroke Cerebrovasc Dis 22:413–418
Seniów J, Bilik M, Leśniak M, Waldowski K, Iwański S, Członkowska A (2012) Transcranial magnetic stimulation combined with physiotherapy in rehabilitation of poststroke hemiparesis: a randomized, double-blind, placebo-controlled study. Neurorehabil Neural Repair 26:1072–1079
Sloan JA, Cella D, Hays RD (2005) Clinical significance of patient-reported questionnaire data: another step toward consensus. J Clin Epidemiol 58:1217–1219
Sung WH, Wang CP, Chou CL, Chen YC, Chang YC, Tsai PY (2013) Efficacy of coupling inhibitory and facilitatory repetitive transcranial magnetic stimulation to enhance motor recovery in hemiplegic stroke patients. Stroke 44:1375–1382
Takeuchi N, Chuma T, Matsuo Y, Watanabe I, Ikoma K (2005) Repetitive transcranial magnetic stimulation of contralesional primary motor cortex improves hand function after stroke. Stroke 36:2681–2686
Takeuchi N, Tada T, Toshima M, Chuma T, Matsuo Y, Ikoma K (2008) Inhibition of the unaffected motor cortex by 1 Hz repetitive transcranical magnetic stimulation enhances motor performance and training effect of the paretic hand in patients with chronic stroke. J Rehabil Med 40:298–303
Talelli P, Greenwood RJ, Rothwell JC (2007) Exploring Theta Burst Stimulation as an intervention to improve motor recovery in chronic stroke. Clin Neurophysiol 118:333–342
Talelli P, Wallace A, Dileone M, Hoad D, Cheeran B, Oliver R et al (2012) Theta burst stimulation in the rehabilitation of the upper limb: a semirandomized, placebo controlled trial in chronic stroke patients. Neurorehabil Neural Repair 26:976–987
Theilig S, Podubecka J, Bösl K, Wiederer R, Nowak DA (2011) Functional neuromuscular stimulation to improve severe hand dysfunction after stroke: does inhibitory rTMS enhance therapeutic efficiency? Exp Neurol 230(1):149–155
Wang CP, Tsai PY, Yang TF, Yang KY, Wang CC (2014) Differential effect of conditioning sequences in coupling inhibitory/facilitatory repetitive transcranial magnetic stimulation for poststroke motor recovery. CNS Neurosci Ther 20:355–363
Ward NS, Cohen LG (2004) Mechanisms underlying recovery of motor function after stroke. Arch Neurol 61:1844–1848
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Platz, T. (2016). Clinical Applications of rTMS in Motor Rehabilitation After Stroke. In: Platz, T. (eds) Therapeutic rTMS in Neurology. Springer, Cham. https://doi.org/10.1007/978-3-319-25721-1_4
Download citation
DOI: https://doi.org/10.1007/978-3-319-25721-1_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-25719-8
Online ISBN: 978-3-319-25721-1
eBook Packages: MedicineMedicine (R0)