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Repetitive cortical stimulation improves motor function after stroke
NEW YORK (Reuters Health) - Repetitive transcranial magnetic stimulation (rTMS) of the unaffected hemisphere improves motor function after stroke, according to a report in the August issue of Stroke.
"Cortical stimulation is a therapy that might help stroke recovery and therefore should be further explored in larger studies," Dr. Felipe Fregni from Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, told Reuters Health.In a phase II trial, Dr. Fregni and colleagues studied the efficacy and safety of repeated consecutive sessions of low-frequency rTMS of the unaffected hemisphere on motor function in 15 patients who had an ischemic stroke more than 1 year ago and had mild-to-moderate motor deficits.
After 5 days, motor function improved significantly in the 10 patients treated with rTMS, the authors report, compared with the 5 patients treated with sham rTMS. The improvements in motor function persisted for 2 weeks after treatment, the results indicate.
Stimulation was associated with a significant decrease in the corticospinal excitability of the unaffected hemisphere and a significant increase in the corticospinal excitability of the affected hemisphere, the researchers note.
Patients with milder motor deficits and greater corticospinal excitability increases in the affected hemisphere appeared to have greater improvements in motor function, the investigators noted.
Treatment was not associated with cognitive change, and patients tolerated the treatment well.
"The use and investigation of neuromodulatory approaches for the treatment of neuropsychiatric disorders have been increasing rapidly in the last few years," Dr. Fregni said. "New FDA applications for the approval of TMS for the treatment of depression and epidural stimulation for the treatment of stroke are being currently evaluated."
"Therefore, this is a field that might have a major impact in neuropsychiatry in the near future," he said.
Dr. Fregni is currently "planning a study to evaluate whether rTMS would have similar beneficial effects in patients with severe motor deficits and also another study to evaluate the effects of rTMS combined with physical therapy."
