Effect Of Repetitive Transcranial Magnetic Stimulation On Motor Functions And MEP In Patients With Stroke

Objective:Repetitive transcranial magnetic stimulation (rTMS) was introduced as a therapeutic non-invasive tool for improving the efficacy of rehabilitation for recovery after stroke. It is evident that disturbances of interhemispheric processes after stroke result in a pathological hyperactivity of the intact hemisphere and a pathological hyperinhibition of the affected hemisphere. Although there has been extensive research on the effectiveness of repetitive transcranial magnetic stimulation (rTMS) to improve patients’motor performance after experiencing chronic stroke, explicit findings on the coupling of different rTMS protocols are meager. The purpose of this study is to investigate the potential for a consecutive suppressive-facilitatory TMS protocol to improve motor outcomes after chronic stroke.Methods:Choose a total of29chronic hemiplegic stroke patients who received rehabilitation that during October2012to January2014from Shandong Provincial Hospital. Record the patient’s age,gender,pathogenic site of hemisphere, catogary of stroke and the time of first-ever stroke. Thirty-one chronic hemiplegic stroke patients were randomly allocated across2groups to undergo42daily sessions of the same extent medical therpy and traditional rehabilitation therpy (physical therpy and occupational therpy).The two groups are treated group and controlled group.On the one hand,1Hz rTMS over the contralesional primary motor cortex (Ml) and iTBS stimulation over the ipsilesional M1(treated group),either of which lasted15minutes.On the other hand,bilateral sham-control procedures (controlled group)lasted the same time as treated group. Fugl-Meyer Assessment, Barthel index, MEP amplitude and MEP latency were measured twice, just at the baseline, and postconsequent rTMS periods.Results:Compared with the controlled group, those receving active rTMS as1Hz rTMS over the contralesional primary motor cortex (Ml) and5Hz stimulation over the ipsilesional Ml showed statistically significant improvement on the aspects which include Fugl-Meyer Assessment, Barthel index, MEP amplitude and MEP latency after6weeks (P<0.05). No significant adverse event on cognition were observed during treatment in either group.Conclusion:Our clinical trials established an extended time frame during which conditioning could be safely continued and produced more favorable outcomes in facilitating motor performance and ameliorating interhemispheric imbalance than those obtained from controlled group. Compared with the controlled group, those receving active rTMS as1Hz rTMS over the contralesional primary motor cortex (M1) and5Hz stimulation over the ipsilesional M1showed improvement on the aspects which include Fugl-Meyer Assessment, Barthel index, MEP amplitude and MEP latency after6weeks. Therefore we can make use of low-frequency rTMS of≤1Hz to suppress while high-frequency rTMS of≥5Hz to facilitate local neural activities improving motor outcomes after chronic stroke. All in all repetitive transcranial magnetic stimulation (rTMS) is a therapeutic non-invasive tool for improving the efficacy of rehabilitation for recovery after stroke.