A Sham-Controlled Trial of a 5-Day Course of Repetitive Transcranial Magnetic Stimulation of the Unaffected Hemisphere in Stroke Patients

Fregni, Felipe; Boggio, Paulo S.; Valle, Angela C.; Rocha, Renata R.; Duarte, Julia; Ferreira, Merari J.L.; Wagner, Tim; Fecteau, Shirley; Rigonatti, Sergio P.; Riberto, Marcelo; Freedman, Steven D.; Pascual‐Leone, Álvaro

doi:10.1161/01.str.0000231390.58967.6b

Cited by 450 publications

(405 citation statements)

References 14 publications

Supporting

Mentioning

357

Contrasting

Unclassified

Order By: Relevance

“…The preservation of MEPs by TMS in the early period after stroke may portend good functional recovery. Fregni et al [12] randomly assigned 15 patients with chronic stroke to receive active or sham rTMS of the unaffected hemisphere. Compared with sham rTMS, active rTMS resulted in a significant improvement in motor function performance in the affected hand that lasted for 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

Effects of Mental Practice in Conjunction with Repetitive Transcranial Magnetic Stimulation on the Upper Limbs of Sub-acute Stroke Patients

Ji¹,

Kim²,

Cha³

2014

Journal of Magnetics

View full text Add to dashboard Cite

The aim of the present study was to examine whether mental practice (MP) in conjunction with repetitive transcranial magnetic stimulation (rTMS) can improve the upper limb function of sub-acute stroke patients. This study was conducted with 32 subjects who were diagnosed with hemiparesis by stroke. The experimental group consisted of 16 members upon each of whom was performed MP in conjunction with rTMS, whreas the control group consisted of 16 members upon each of whom was performed MP and sham rTMS. Both groups received traditional physical therapy for 30 minutes a day, 5 days a week, for 6 weeks; additionally, they received mental practice for 15 minutes a day. The experimental group was instructed to perform rTMS, and the control group was instructed to apply sham rTMS for 15 minutes. A motor cortex excitability analysis was performed by motor evoked potentials (MEPs), and upper limb function was evaluated by Fugl-Meyer Assessment (FMA) and the Box and Block test (BBT). Results showed that the amplitude, latency, FMA, and BBT of the experimental group and the latency, FMA, and BBT of the control group were significantly improved after the experiment (p<0.05). Significant differences were found between the groups in amplitude and latency after the experiment (p<0.05). The results showed that MP in conjunction with rTMS is more effective in improving upper limb function than MP alone.

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of Mental Practice in Conjunction with Repetitive Transcranial Magnetic Stimulation on the Upper Limbs of Sub-acute Stroke Patients

Ji¹,

Kim²,

Cha³

2014

Journal of Magnetics

View full text Add to dashboard Cite

show abstract

“…tDCS, depending on the polarity, can also enhance (anodal) or suppress (cathodal) excitability of the targeted cortex [43]. Studies have generally downregulated contralesional activity using low-frequency rTMS [44] or cathodal tDCS [45], or upregulated ipsilesional activity using high-frequency rTMS [46] or anodal tDCS [47], or simultaneously applied both [48,49].…”

Section: Are There Other Processes That Can Be Effective To Modulate mentioning

confidence: 99%

Invasive Neurostimulation in Stroke Rehabilitation

Plow

Machado

2014

Neurotherapeutics

View full text Add to dashboard Cite

The last decade has seen a growing interest in adjuvant treatments that synergistically influence mechanisms underlying rehabilitation of paretic upper limb in stroke. One such approach is invasive neurostimulation of spared cortices at the periphery of a lesion. Studies in animals have shown that during training of paretic limb, adjuvant stimulation targeting the peri-infarct circuitry enhances mechanisms of its reorganization, generating functional advantage. Success of early animal studies and clinical reports, however, failed to translate to a phase III clinical trial. As lesions in humans are diffuse, unlike many animal models, peri-infarct circuitry may not be a feasible, or consistent target across most. Instead, alternate mechanisms, such as changing transcallosal inhibition between hemispheres, or reorganization of other viable regions in motor control, may hold greater potential. Here, we review comprehensive mechanisms of clinical recovery and factors that govern which mechanism(s) become operative when. We suggest novel approaches that take into account a patient's initial clinical-functional state, and findings from neuroimaging and neurophysiology to guide to their most suitable mechanism for ideal targeting. Further, we suggest new localization schemes, and bypass strategies that indirectly target peri-lesional circuitry, and methods that serve to counter technical and theoretical challenge in identifying and stimulating such targets at the periphery of infarcts in humans. Last, we describe how stimulation may modulate mechanisms differentially across varying phases of recovery-a temporal effect that may explain missed advantage in clinical trials and help plan for the next stage. With information presented here, future trials would effectively be able to target patient's specific mechanism(s) with invasive (or noninvasive) neurostimulation for the greatest, most consistent benefit. [2], which remains one of the most important predictors of disability and poor quality of life [3]. Disability adds to the costs of disease management that total $74 billion/ year [4]. Developing methods to effectively alleviate residual deficits will reduce health and economic burden of stroke.Several evidence-based rehabilitative approaches have been developed with prominent ones, including neuromuscular electrical stimulation [5], motor learning [6], robotic training [7] constraint-induced movement therapy [8], and bilateral arm training [9], etc. In spite of extensive therapy, recovery is frequently incomplete [10]. There is a critical need for adjuvant strategies that augment rehabilitative outcomes of paretic hand.The last decade has seen a growing interest in the promise of adjuvant treatments that synergistically influence mechanisms associated with rehabilitation. One such approach is invasive neuromodulation, involving electrical stimulation applied to cortical or subcortical targets spared by stroke. By directly stimulating viable targets, it is believed that potential for plasticity underlying reh...

show abstract

“…Thus, motor plasticity and improved outcome with rTMS can be induced either by low-frequency rTMS over the less injured hemisphere or highfrequency rTMS over the more injured hemisphere. Takeuchi et al (2005) and Fregni et al (2006) evaluated the effects of low-frequency rTMS of the intact hemisphere after this suppressive protocol of motor cortex excitability. Takeuchi et al (2005) observed a reduction of the transcallosal inhibition from the intact hemisphere in response to rTMS of the damaged M1 and Fregni et al (2006) a reduction of the MT in response to rTMS of the damaged motor cortex.…”

Section: Neuroplasticity Induced By Repetitive Transcranialmentioning

confidence: 99%

Effects of Repetitive Transcranial Magnetic Stimulation on Dystonia: An Overview

Machado¹,

Arias-Carrión²,

Paes³

et al. 2011

American Journal of Neuroscience

View full text Add to dashboard Cite

Problem statement: Repetitive Transcranial Magnetic Stimulation (rTMS) is a noninvasive procedure whereby a pulsed magnetic field stimulates electrical activity in the brain. Dystonia is characterized by several disabling symptoms for which effective, mechanism-based treatments remain elusive. Approach: Consequently, more advanced non-invasive therapeutic methods were required. A possible method to modulate brain activity and potentially viable for use in clinical practice was rTMS. We focus on the basic foundation of rTMS, the effects of rTMS on neuroplasticity and sensorimotor integration and the experimental advances of rTMS that may become a viable clinical application to treat dystonia. Results: The findings showed that rTMS can improve some symptoms associated with dystonia and might be useful for promoting cortical plasticity in dystonic patients. These changes were transient and it is premature to propose these applications as realistic therapeutic options, even though the rTMS technique has shown itself to be, potentially, a modulator of sensorimotor integration and neuroplasticity. Conclusion/Recommendations: Functional imaging of the region of interest could highlight the capacity of rTMS to bring about plastic changes of the cortical circuitry and hint at future novel clinical interventions. We recommend further studies to clearly determine the role of rTMS in the treatment of these conditions. Finally, we must remember that however exciting the neurobiological mechanisms might be, the clinical usefulness of rTMS will be determined by their ability to provide patients with neurological and psychiatric disorders with safe, long-lasting and substantial improvements in quality of life.

show abstract

A Sham-Controlled Trial of a 5-Day Course of Repetitive Transcranial Magnetic Stimulation of the Unaffected Hemisphere in Stroke Patients

Cited by 450 publications

References 14 publications

Effects of Mental Practice in Conjunction with Repetitive Transcranial Magnetic Stimulation on the Upper Limbs of Sub-acute Stroke Patients

Effects of Mental Practice in Conjunction with Repetitive Transcranial Magnetic Stimulation on the Upper Limbs of Sub-acute Stroke Patients

Invasive Neurostimulation in Stroke Rehabilitation

Effects of Repetitive Transcranial Magnetic Stimulation on Dystonia: An Overview

Contact Info

Product

Resources

About