Effects of repetitive transcranial magnetic stimulation and intensive occupational therapy on motor neuron excitability in poststroke hemiparetic patients: A neurophysiological investigation using F-wave parameters

Abstract

The 15-day protocol of LF-RTMS/OT produced significant reduction of motor neuron excitability. RTMS/OT can potentially produce significant reduction in upper limb spasticity in the affected upper limb, although this finding should be confirmed in a larger number of patients.

Spasticity Management: The Current State of Transcranial Neuromodulation

“…Based on the accumulated data from the literature survey, we can highlight 2 main points on the use of NINM for spasticity management: (1) NINM is useful in reducing spasticity, but its effects critically depend on the applied hemisphere and the underlying pathology [45]; and (2) NINM is more effective in reducing spasticity when coupled with another form of medical and/or physical therapy rather than used as a stand‐alone therapy [39,46‐48,56,58,65,70‐72].…”

“…Only a few reports support the conclusion that rTMS and tDCS are effective as a single intervention, whereas there is evidence suggesting that rTMS and tDCS contribute only by improving the outcomes of medical and/or physical therapy [39,46‐48,56,58,65]. The superiority of the combined approach may be justified by the principles of priming or of associative plasticity [29‐31].…”

“…Most of the studies used low‐frequency rTMS over the healthy hemisphere in stroke patients [44‐56] or the less affected side in the patients with multiple sclerosis [57]. Some studies used stand‐alone high‐frequency rTMS or intermittent theta‐burst stimulation (a type of high‐frequency rTMS in which patterned magnetic stimuli, ie, grouped in repeated small trains of stimuli, are used) [41,49,55‐64], combined high‐frequency with low‐frequency rTMS, or used combined approaches [46‐49,58,65]. Among the combined approaches, NINM was intended as a primer; that is, rTMS constituted a pretreatment or pre‐protocol stimulation that enhances the effect of subsequent treatments.…”

Effect of different pulse numbers of transcranial magnetic stimulation on motor cortex excitability: Single‐blind, randomized cross‐over design

“…Currently, however, there is no consensus on the optimal number of rTMS pulses required to achieve cortical excitability. Previous studies have used 150 to more than 2000 pulses for rTMS . Different rTMS pulse numbers might affect the changes in MEP amplitude and the effect duration.…”

“…Previous studies have used 150 to more than 2000 pulses for rTMS. [13][14][15] Different rTMS pulse numbers might affect the changes in MEP amplitude and the effect duration.…”