The Effect of Repetitive Transcranial Magnetic Stimulation Combined with Upper Limb Exercise on the Motor Function of Hemiplegic Upper Limb

J Korean Assoc EMG Electrodiagn Med 2010;12(1):24-31.
Published online June 1, 2010.

Abstract

Objective: To evaluate whether 5-day course of high-frequency rTMS over the affected hemisphere combined with a carrying-cups exercise can improve the motor function of the hemiplegic upper limb and whether this effect is maintained. Methods: Nineteen patients with subacute and chronic hemiparetic stroke who are able to practice a carrying- cups exercise were randomized to either active rTMS combined with carrying-cups exercise (n=10) or sham rTMS combined with carrying-cups exercise (n=9) group. Participants received five day course of rTMS over the primary motor cortex of the affected hemisphere with the following parameters : intensity of 80 percent motor threshold (MT), frequency of 10 Hz, duration of 3 second, 8 trains, i.e. totally 240 stimuli per day. For the sham stimulation, we applied the same method as active rTMS, except that the stimulation intensity of 2 percent MT, which is weak enough not to induce corticomotor excitability change. One treatment session consists of 3 second rTMS followed by 40 second exercise and 27 second rest. All participants repeated 8 sessions daily for five consecutive days in a patient-assessor double blinded manner. Results: The active rTMS treatment group showed a significant improvement in the Wolf Motor Function Test-time in the affected hand when estimated 3 days after treatment, which lasted for 2 weeks, while the sham rTMS group did not. Conclusions: 5-day course of high-frequency rTMS over the affected hemisphere combined with upper limb exercise improved the motor function of the hemiplegic upper limb and its effect lasted at least for 2 weeks in subacute and chronic phase of stroke patients.

Key Words: rTMS, Stroke, Hemiplegia, Hand function