Comparison of the Effect of Low-Frequency Repetitive Transcranial Magnetic Stimulation with That of Theta Burst Stimulation on Upper Limb Motor Function in Poststroke Patients

Abstract

Background The purpose of this study was to evaluate the difference between the therapeutic effect of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and that of continuous theta burst stimulation (cTBS), when each is combined with intensive occupational therapy (OT), in poststroke patients with upper limb hemiparesis. Materials and Methods The study subjects were 103 poststroke patients with upper limb hemiparesis, who were divided into two groups: the LF-rTMS group (n = 71) and the cTBS group (three pulse bursts at 50 Hz) (n = 32). Each subject received 12 sessions of repetitive transcranial magnetic stimulation of 2,400 pulses applied to the nonlesional hemisphere and 240-min intensive OT (two 60-min one-to-one training sessions and two 60-min self-training exercises) daily for 15 days. Motor function was evaluated using the Fugl-Meyer Assessment (FMA) and the performance time of the Wolf motor function test (WMFT) was determined on the days of admission and discharge. Results Both groups showed a significant increase in the FMA score and a short log performance time of the WMFT (p < 0.001), but the increase in the FMA score was higher in the LF-rTMS group than the cTBS group (p < 0.05). Conclusion We recommend the use of 2400 pulses of LF-rTMS/OT for 2 weeks as treatment for hemiparetic patients.

Predicting Recovery of Upper Extremity Motor Function After Stroke According to the NovEl Intervention Using Repetitive Transcranial Magnetic Stimulation and Occupational Therapy: NEURO

“…14 Since there were no data on the time of onset of stroke in patients, it was difficult to estimate and compare the predicted scores of the spontaneous biological recovery using the PRR formula. 13, 14 However, these results are consistent with those of previous reports, 7, 18 and more than half of patients with NEURO who had a longer time since the onset of stroke recovered more. How NEURO alters the spontaneous recovery estimated in chronic stroke patients needs to be tested using acute phase data.…”

“…[3][4][5] Our NovEl intervention using repetitive transcranial magnetic stimulation and intensive occupational therapy (NEURO) is one of the effective interventions for poststroke upper extremity paralysis because it combines the low-frequency repetitive transcranial magnetic stimulation (rTMS) to the intact cerebral cortex with the intensive occupational therapy (OT). [6][7][8] Because motor paralysis affects activities of daily living (ADLs) in stroke patients, predicting recovery during rehabilitation is important. A recent model suggested that recovery is better if patients achieves their goals.…”

“…[15][16][17] Although the PRR and the PREP algorithms can be used within days of stroke patients to provide accurate predictions of the upper extremity functional outcomes at 3 to 6 months after stroke. 14,17 Patients who were treated with NEURO were those who had stroke for longer than 6 months; 7,18 therefore, it was difficult to predict the recovery from hemiparesis without the initial acute values, such as in those who received NEURO. On the other hand, the long-term recovery prediction models, as time series functional changes, were substituted into a logarithmic model for analysis.…”

Prediction of Motor Recovery in the Upper Extremity for Repetitive Transcranial Magnetic Stimulation and Occupational Therapy Goal Setting in Patients With Chronic Stroke: A Retrospective Analysis of Prospectively Collected Data

“…To verify if the upper extremity function was maintained after NEURO, patients were excluded: (1) if they did not have at least one FMA score before and after treatment, (2) if they had an initial FMA for upper extremity (FMA-UE) score <26/66, with severe motor impairment (15,23), and those with a diagnosis of subarachnoid hemorrhage were excluded.…”

“…Focal 1 Hz rTMS was applied to the contralesional hemisphere over the primary motor area, as described in previous studies (15,23). A 70-mm figure-8 coil, attached to a MagPro R100 stimulator (MagVenture Company, Farum, Denmark) was used for rTMS application; for this, 2,400 pulses lasting for 40 min were applied.…”