Background and Purpose-The purpose of this study was to perform a meta-analysis of studies that investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on upper limb motor function in patients with stroke. Methods-We searched for randomized controlled trials published between January 1990 and October 2011 in PubMed, Medline, Cochrane, and CINAHL using the following key words: stroke, cerebrovascular accident, and repetitive transcranial magnetic stimulation. The mean effect size and a 95% CI were estimated for the motor outcome and motor threshold using fixed and random effect models. Results-Eighteen of the 34 candidate articles were included in this analysis. The selected studies involved a total of 392 patients. A significant effect size of 0.55 was found for motor outcome (95% CI, 0.37-0.72). Further subgroup analyses demonstrated more prominent effects for subcortical stroke (mean effect size, 0.73; 95% CI, 0.44 -1.02) or studies applying low-frequency rTMS (mean effect size, 0.69; 95% CI, 0.42-0.95). Only 4 patients of the 18 articles included in this analysis reported adverse effects from rTMS. Conclusions-rTMS has a positive effect on motor recovery in patients with stroke, especially for those with subcortical stroke. Low-frequency rTMS over the unaffected hemisphere may be more beneficial than high-frequency rTMS over the affected hemisphere. Recent limited data suggest that intermittent theta-burst stimulation over the affected hemisphere might be a useful intervention. Further well-designed studies in a larger population are required to better elucidate the differential roles of various rTMS protocols in stroke treatment. (Stroke. 2012;43:1849-1857.)

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BackgroundMutations in the PRRT2 gene have recently been identified in patients with familial paroxysmal kinesigenic dyskinesia with infantile convulsions (PKD/IC) and patients with sporadic PKD/IC from several ethnic groups. To extend these recent genetic reports, we investigated the frequency and identities of PRRT2 mutations in a cohort of Taiwanese patients with PKD/IC.Methodology and Principal FindingsWe screened all 3 coding exons of PRRT2 for mutations in 28 Taiwanese patients with PKD/IC. Among them, 13 had familial PKD/IC and 15 were apparently sporadic cases. In total, 7 disparate mutations were identified in 13 patients, including 8 familial cases and 5 apparently sporadic cases. The mutations were not present in 500 healthy controls. Four mutations were novel. One patient had a missense mutation and all other patients carried PRRT2 mutations putatively resulting in a protein truncation. Haplotype analysis revealed that 5 of the 7 patients with the PRRT2 p.R217Pfs*8 mutation shared the same haplotype linked to the mutation.Conclusions and Significance PRRT2 mutations account for 61.5% (8 out of 13) of familial PKD/IC and 33.3% (5 out of 15) of apparently sporadic PKD/IC in the Taiwanese cohort. Most patients with the PRRT2 p.R217Pfs*8 mutation in Taiwan likely descend from a single common ancestor. This study expands the spectrum of PKD/IC-associated PRRT2 mutations, highlights the pathogenic role of PRRT2 mutations in PKD/IC, and suggests genetic heterogeneity within idiopathic PKD.

Inherent fuzzy entropy is an objective measurement of electroencephalography (EEG) complexity, reflecting the robustness of brain systems. In this study, we present a novel application of multi-scale relative inherent fuzzy entropy using repetitive steady-state visual evoked potentials (SSVEPs) to investigate EEG complexity change between two migraine phases, i.e. inter-ictal (baseline) and pre-ictal (before migraine attacks) phases. We used a wearable headband EEG device with O1, Oz, O2 and Fpz electrodes to collect EEG signals from 80 participants (40 migraine patients and 40 healthy controls [HCs]) under the following two conditions: during resting state and SSVEPs with five 15-Hz photic stimuli. We found a significant enhancement in occipital EEG entropy with increasing stimulus times in both HCs and patients in the inter-ictal phase but a reverse trend in patients in the pre-ictal phase. In the 1 st SSVEP, occipital EEG entropy of the HCs was significantly higher than that of patents in the pre-ictal phase (FDR-adjusted p < 0.05). Regarding the transitional variance of EEG entropy between the 1 st and 5 th SSVEPs, patients in the pre-ictal phase exhibited significantly lower values than patients in the inter-ictal phase (FDR-adjusted p < 0.05). Furthermore, in the classification model, the AdaBoost ensemble learning showed an accuracy of 81±6% and AUC of 0.87 for classifying inter-ictal and pre-ictal phases. In contrast, there were no differences in EEG entropy among groups or sessions by using other competing entropy models, including approximate entropy, sample entropy and fuzzy entropy on the same dataset. In conclusion, inherent fuzzy entropy offers novel applications in visual stimulus environments and may have the potential to provide a pre-ictal alert to migraine patients.

Our results indicate that cTBS on the primary motor cortex might reduce the number of total headache and migraine days in patients with migraine. However, large-scale randomized controlled trials are necessary to further validate the findings.

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