Deep Repetitive Transcranial Magnetic Stimulation With H-coil on Lower Limb Motor Function in Chronic Stroke: A Pilot Study

Chieffo, Raffaella; Prezzo, Serena De; Houdayer, Elise; Nuara, Arturo; Maggio, G. Di; Coppi, Elisabetta; Ferrari, Laura De; Straffi, L.; Spagnolo, Fabio; Velikova, S.; Sessa, Maria; Comola, M.; Zangen, Abraham; Comı, Gıancarlo; Leocani, Letizia

doi:10.1016/j.apmr.2014.02.019

Cited by 43 publications

(41 citation statements)

References 32 publications

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“…It is thought that cathodal stimulation of the unaffected hemisphere will cause a suppression of activity locally, allowing for the transcallosal disinhibition of the affected hemisphere, thereby increasing neuroplastic response to repair itself [17]. This same mechanism has been proposed for the improvement of neurocognitive deficits in stroke patients; specifically in task related functions [18], as well as, memory and affective complications [19][20][21]. These results, though minimal, are statistically significant in demonstrating that modulation of ipsilesional activity can improve motor recovery, likely by promoting plastic reorganization of spared cortex.…”

Section: Transcranial Magnetic Stimulation/transcranial Direct Currenmentioning

confidence: 90%

“…Furthermore, a recent meta-analysis studied the effects of TMS on neuropathic pain, including post-stroke supra-spinal related pain, and concluded that TMS provides a significant reduction invarious neuropathic pain conditions [21][22][23][24][25]. There are three main proposed mechanisms for this: 1) induction of neuroplasticity can allow for the brain to simply reorganize itself in a way that reverses the plasticity induced with neuropathic pain, 2) direct stimulation of descending inhibitory pathways to decrease the response to painful stimuli, 3) direct stimulation of endogenous opioid secretions [19]. With promising results in the recovery of motor function, cognition, and pain management, TMS may be a fruitful option in post-acute stroke recovery for certain patients.…”

Section: Transcranial Magnetic Stimulation/transcranial Direct Currenmentioning

confidence: 99%

“…The mechanism of action is via the incorporation of different portions of the brain associated with a functional task by using sensory stimuli to reinforce the connections and therefore improve the performance of that task [19]. Increasing the activity of a neuron can strengthen the connections it makes with other neurons.…”

Section: Visual and Auditory Brain Stimulationmentioning

confidence: 99%

“…A recent study, aimed to assess the efficacy of high-frequency brain stimulation on lower limb motor function in patients with chronic subcortical stroke, examined repetitive TMS, targeting deeper and larger brains regions, demonstrated that three weeks of treatment could induce long-term improvements in lower limb function, lasting beyond the end of the treatment [19]. Furthermore, a recent meta-analysis studied the effects of TMS on neuropathic pain, including post-stroke supra-spinal related pain, and concluded that TMS provides a significant reduction invarious neuropathic pain conditions [21][22][23][24][25].…”

Section: Transcranial Magnetic Stimulation/transcranial Direct Currenmentioning

confidence: 99%

See 3 more Smart Citations

The Promising Role of Neuromodulation in Improving Ischemic Stroke Recovery

LoPresti¹,

Camacho²,

Appelboom³

et al. 2015

J Neurol Neurosurg

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Strokes continue to be a leading cause of death and carries significant morbidity impacting the quality of life for survivors. Although there are preventative measures and growing hyperacute treatments, physical and occupational rehabilitation continue to be the main modalities for recovery of motor abilities, cognitive function, and resolution of pain syndromes post-stroke. Neuromodulation therapies hold great promise for stroke survivors and are beginning to gain traction as the next frontier in regards to post-stroke rehabilitation. It is the aim of this review to explore current beliefs regarding post-acute stroke recovery through neuroplasticity of surviving brain tissue and the impact of neuromodulation through non-invasive and invasive interventions. By understanding the scope of these interventions, the areas in which neuromodulation may be most effective, and the types of recovery they may help constitute, the impact of neuromodulation as a budding area in neurological care and therapy can be better characterized and outlined for future study.

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Section: Transcranial Magnetic Stimulation/transcranial Direct Currenmentioning

confidence: 90%

Section: Transcranial Magnetic Stimulation/transcranial Direct Currenmentioning

confidence: 99%

Section: Visual and Auditory Brain Stimulationmentioning

confidence: 99%

Section: Transcranial Magnetic Stimulation/transcranial Direct Currenmentioning

confidence: 99%

See 2 more Smart Citations

The Promising Role of Neuromodulation in Improving Ischemic Stroke Recovery

LoPresti¹,

Camacho²,

Appelboom³

et al. 2015

J Neurol Neurosurg

View full text Add to dashboard Cite

show abstract

“…10 Several studies comparing the effects of different rTMS sessions used washout periods of 2-4 weeks in duration. 10,11,34 Our use of a 4-week washout period between different rTMS QP regimens in the present study is therefore not without precedent. Nevertheless, a more rigorous study design would call for either a longer washout period between 5-day sessions of rTMS QP , or randomization of the presentation order of the different regimens used.…”

Section: Alexeeva and Calancie Efficacy Of Quadropulse Rtms For Impromentioning

confidence: 99%

Efficacy of QuadroPulse rTMS for improving motor function after spinal cord injury: Three case studies

Alexeeva

Calancie

2014

The Journal of Spinal Cord Medicine

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Context/objective: To examine the effects of repetitive QuadroPulse transcranial magnetic stimulation (rTMS QP ) on hand/leg function after spinal cord injury (SCI). Design: Interventional proof-of-concept study. Setting: University laboratory. Participants: Three adult subjects with cervical SCI. Interventions: Repeated trains of magnetic stimuli were applied to the motor cortical hand/leg area. Several exploratory single-day rTMS QP protocols were examined. Ultimately we settled on a protocol using three 5-day trials of (1) rTMS QP only; (2) exercise only (targeting hand or leg function); and (3) rTMS QP combined with exercise. Outcome measures: Hand motor function was assessed by Purdue Pegboard and Complete Minnesota Dexterity tests. Walking function was based on treadmill walking and the Timed Up and Go test. Electromyographic recordings were used for neurophysiological testing of cortical (by single-and doublepulse TMS) and spinal (via tendon taps and electrical nerve stimulation) excitability. Results: Single-day rTMS QP application had no clear effect in the 2 subjects whose hand function was targeted, but improved walking speed in the person targeted for walking, accompanied by increased cortical excitability and reduced spinal excitability. All 3 subjects showed functional improvement following the 5-day rTMS QP intervention, an effect being even more pronounced after the five-day combined rTMS QP + exercise sessions. There were no rTMS QP -associated adverse effects. Conclusion: Our findings suggest a functional benefit of motor cortical rTMS QP after SCI. The effect of rTMS QP appears to be augmented when stimulation is accompanied by targeted exercises, warranting expansion of this pilot study to a larger subject population.

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Applying transcranial magnetic stimulation to rehabilitation of poststroke lower extremity function and an improvement: Individual‐target TMS

Tian²,

Rao

et al. 2022

WIRES Cognitive Science

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Stroke is the leading cause of disability globally in need of novel and effective methods of rehabilitation. Intermittent theta burst stimulation (iTBS) has been adopted as a Level B recommendation for lower limb spasticity in guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Nonetheless, the methodological differences and deficits of existing work bring about heterogenous results and therefore limit the universal clinical use of rTMS in lower extremity (LE) rehabilitation. The variation of stimulated targets across motor cortex contributes mainly to these heterogeneities. This narrative review includes studies of rTMS on LE motor function rehabilitation in patients after stroke until now. Some analyses of brain imaging and electromagnetic simulation and quantification through computational modeling were also performed. rTMS appears capable of fostering LE motor rehabilitation after stroke, but the actually stimulated targets are considerably bias making it difficult to confirm effectiveness. The main reason for this phenomenon is probably inaccurate targeting of motor cortical leg representation. An underlying updated method is proposed as Individual‐Target TMS (IT‐TMS) combined with brain imaging. rTMS is a promising validated method for LE function regaining. Future studies should systematically compare the effects of IT‐TMS with traditional rTMS using large samples in random clinical trials. This article is categorized under: Neuroscience > Clinical Neuroscience

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Deep Repetitive Transcranial Magnetic Stimulation With H-coil on Lower Limb Motor Function in Chronic Stroke: A Pilot Study

Cited by 43 publications

References 32 publications

The Promising Role of Neuromodulation in Improving Ischemic Stroke Recovery

The Promising Role of Neuromodulation in Improving Ischemic Stroke Recovery

Efficacy of QuadroPulse rTMS for improving motor function after spinal cord injury: Three case studies

Applying transcranial magnetic stimulation to rehabilitation of poststroke lower extremity function and an improvement: Individual‐target TMS

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