Clinical Applications of rTMS in Motor Rehabilitation After Stroke
- 686 Downloads
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.
KeywordsStroke Patient Rest Motor Threshold Motor Recovery Sham Stimulation Chronic Stroke Patient
- 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 66:719–725CrossRefPubMedGoogle Scholar
- 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 95:1141–1147CrossRefPubMedGoogle Scholar
- Hao Z, Wang D, Zeng Y, Liu M (2013) Repetitive transcranial magnetic stimulation for improving function after stroke. Cochrane Database Syst Rev (5):CD008862.Google Scholar
- 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):707–715Google Scholar
- 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):1802–1804Google Scholar
- 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):509–517Google Scholar
- 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 120:2008–2039PubMedCentralCrossRefPubMedGoogle Scholar
- 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 26:1072–1079CrossRefPubMedGoogle Scholar
- 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 40:298–303CrossRefPubMedGoogle Scholar
- 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):149–155Google Scholar