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This review discusses the clinical results that were obtained by applying rTMS in acute and chronic ischemic stroke patients. These studies included only the recovery of motor disability and dysphagia. In summary, two approaches have been used when employing rTMS as a potential therapy for the treatment of stroke. The most direct approach involves...
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Die nichtinvasive und invasive Motorkortexstimulation können therapierefraktäre neuropathische Schmerzen verbessern. Mit der hochfrequenten repetitiven transkraniellen Magnetstimulation (rTMS) des kontralateralen Motorkortex können kurzzeitige therapeutische Effekte erzielt und der Effekt einer epiduralen Motorkortexstimulation (MCS) vorhergesagt w...
Citations
... Therefore, although short-term changes resulted from tDCS, the possibility of spontaneous recovery must be considered (46,47). Further, which patients would respond well to which tDCS protocols (stimulation site, intensity, stimulus density, and duration) remains undetermined (48). Furthermore, no standardized guidelines regarding the duration of the washout of the stimulation effect have been published (49). ...
Introduction
Activation of the unaffected hemisphere contributes to motor function recovery post stroke in patients with severe upper limb motor paralysis. Transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation to increase the excitability of motor-related areas. tDCS has been reported to improve upper limb motor function; nonetheless, its effects on corticospinal tract excitability and muscle activity patterns during upper limb exercise remain unclear. Additionally, it is unclear whether simultaneously applied bihemispheric tDCS is more effective than anodal tDCS, which stimulates only one hemisphere. This study examined the effects of bihemispheric tDCS training on corticospinal tract excitability and muscle activity patterns during upper limb movements in a patient with subacute stroke.
Methods
In this single-case retrospective study, the Fugl–Meyer Assessment, Box and Block Test, electromyography, and intermuscular coherence measurement were performed. Intermuscular coherence was calculated at 15–30 Hz, which reflects corticospinal tract excitability.
Results
The results indicated that bihemispheric tDCS improved the Fugl–Meyer Assessment, Box and Block Test, co-contraction, and intermuscular coherence results, as compared with anodal tDCS. Discussion: These results reveal that upper limb training with bihemispheric tDCS improves corticospinal tract excitability and muscle activity patterns in patients with subacute stroke.
... Moreover, our study found that by employing combined treatment with LF-rTMS and rPMS, the improvements in spasticity, motor function and mobility of patients were more significant than those of the LF-rTMS and control groups. As a non-invasive brain stimulation technique, LF-rTMS can not only induce cortical neuroplasticity and strengthen the connection between cortical neurons, but also temporarily increase cerebral blood flow and improve corticospinal tract function, which is conducive to relieving limb spasticity and promoting motor function rehabilitation (Khedr and Fetoh, 2010;Li Y. et al., 2020;Luk et al., 2022). In addition, rPMS intervention can regulate the proprioceptive delivery nerves, affect proprioceptive and somatosensory input, and strengthen the positive feedback and input of sensory and motor control patterns to the center, which is conducive to improving the motor control of stroke patients (Sakai et al., 2019;El Nahas et al., 2022). ...
Background and objective
Transcranial magnetic stimulation and peripheral repetitive magnetic stimulation (rPMS), as non-invasive neuromodulation techniques, can promote functional recovery in patients with post-stroke spasticity (PSS), but the effects of transcranial magnetic stimulation combined with peripheral magnetic stimulation on PSS remain largely unknown. Therefore, we examined the effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with rPMS on PSS patients and its potential neural correlates to behavioral improvements.
Methods
Forty-nine PSS patients were divided randomly into three groups: a combined group ( n = 20), a LF-rTMS group ( n = 15), and a control group ( n = 14). The combined group received LF-rTMS and rPMS treatment, the rTMS group received LF-rTMS treatment, and the control group received only routine rehabilitation. All patients underwent Ashworth Spasm Scale (MAS), upper extremity Fugl-Meyer (FMA-UE), and modified Barthel Index (MBI) assessments before and after intervention. In addition, resting-state functional magnetic resonance imaging data were collected pre- and post-treatment to observe changes in the amplitude of low-frequency fluctuation (ALFF).
Results
The MAS score was decreased, FMA-UE score and MBI scores were increased in the three groups after therapy than before therapy (all P < 0.05). In particular, the combined group showed significant effect on improved motor function and relieved spasticity in PSS ( P < 0.01). Moreover, the combined treatment increased ALFF values mainly in the right supplementary motor area, right middle frontal gyrus, and right cerebellum, while reduced ALFF values mainly in the right post-central gyrus compared with pre-treatment. Compared with the LF-rTMS and control groups, the combined treatment increased ALFF values in the right cerebellum and reduced ALFF values mainly in the frontoparietal cortex. Improvements in the MAS score were positively correlated with the change in ALFF values in the right cerebellum ( r = 0.698, P = 0.001) and the right supplementary motor area ( r = 0.700, P = 0.001) after combined treatment.
Conclusion
Transcranial combined with peripheral repetitive magnetic stimulation could improve spastic state and motor function in PSS patients, and this effect may be associated with altered cerebellar and frontoparietal cortical activity.
Clinical trial registration
http://www.chictr.org.cn/index.aspx , identifier ChiCTR1800019452.
... Numerous studies have reported that after a stroke on the medial cerebral artery, there is a decrease in corticospinal excitability of the affected motor cortex [9][10][11]; generally, enhanced contralesional excitability and increased interhemispheric inhibition occur. This state is associated with poorer function in the paretic limbs [12][13][14]. ...
... Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive therapeutic tool that can be used to modulate cortical excitability either directly through the application of facilitatory stimulation (high-frequency) over the lesioned hemisphere or indirectly through inhibitory stimulation (low-frequency) to the contralesional hemisphere [9,11,15]. Inhibitory (1-Hz) rTMS applied over the contralesional hemisphere is safe and involves hotspots that are easier to locate and were reported to increase excitability within the ipsilesional hemisphere [16]. Previous studies have demonstrated that 1-Hz rTMS improved walking ability as well as motor function and led to a more symmetrical gait pattern in patients after stroke [17][18][19]. ...
After a stroke, sustained gait impairment can restrict participation in the activities listed in the International Classification of Functioning, Disability, and Health model and cause poor quality of life. The present study investigated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and visual feedback training (VF) training in improving lower limb motor performance, gait, and corticospinal excitability in patients with chronic stroke. Thirty patients were randomized into three groups that received either rTMS or sham stimulation over the contralesional leg region accompanied by VF training groups in addition to the conventional rehabilitation group. All participants underwent intervention sessions three times per week for four weeks. Outcome measures included the motor-evoked potential (MEP) of the anterior tibialis muscle, Berg Balance Scale (BBS) scores, Timed Up and Go (TUG) test scores, and Fugl–Meyer Assessment of Lower Extremity scores. After the intervention, the rTMS and VF group had significantly improved in MEP latency (p = 0.011), TUG scores (p = 0.008), and BBS scores (p = 0.011). The sham rTMS and VF group had improved MEP latency (p = 0.027). The rTMS and VF training may enhance the cortical excitability and walking ability of individuals with chronic stroke. The potential benefits encourage a larger trial to determine the efficacy in stroke patients.
... LF-rTMS can inhibit cortical excitability in the stimulated hemisphere, facilitate excitatory interhemispheric balance, increase contralesional hemisphere excitability, and decrease interhemispheric inhibition to promote the recovery of motor function [40]. Several clinical trials have reported no significant effects of LF-rTMS on upper limb motor-function recovery [41][42][43]. ...
This study investigated the synergistic effects of scalp acupuncture (SA) and repetitive transcranial magnetic stimulation (rTMS), known to be effective for cerebral infarction. This outcome-assessor-blinded, randomized controlled clinical trial included a per-protocol analysis to compare the efficacy of SA and electromagnetic convergence stimulation (SAEM-CS) and single or no stimulation. The trial was conducted with 42 cerebral infarction patients (control group, 12; SA group, 11; rTMS group, 8; SAEM-CS group, 11). All patient groups underwent two sessions of CSRT per day. SA, rTMS, and SAEM-CS were conducted once per day, 5 days per week, for 3 weeks. The primary outcome was evaluated using the Fugl–Mayer assessment (FMA). FMA Upper Extremity, FMA total, MBI, and FIM scores significantly increased in the rTMS group compared with the control group. Additionally, FMA Upper Extremity, FMA total, MBI and FIM scores significantly increased in the rTMS group compared with the SAEM-CS group. However, there were no significant changes in the SA or SAEM-CS groups. In conclusion, low-frequency rTMS in the contralesional hemisphere may have long-term therapeutic effects on upper extremity motor function recovery and improvements in activities of daily living. SAEM-CS did not show positive synergistic effects of SA and rTMS.
... Perhaps, rTMS is very actively used for the treatment of depression [23], neurogenic pain syndromes, as well as to compensate motor deficiency in patients with limb paresis [24]. There are effective rTMS modes for treatment of consequences of stroke [4,[25][26][27], including protocols incorporated into international guidelines [28]. rTMS protocols for head injury are less clear [5,29,30]. ...
... rTMS protocols for head injury are less clear [5,29,30]. rTMS for restoration of patients with impaired consciousness after severe TBI is being studied [7,29,25,[31][32][33]. ...
... Stimulation of sagittal parts of motor area was effective in patients with Parkinson's disease [4]. Isolated potentiation rTMS of the motor cortex [4,27,30] in damaged hemisphere or in combination with inhibitory stimulation of the intact hemisphere [4,25] is used after stroke. More recent studies have shown that the most effective motor recovery after stroke is ensured by stimulation of either both hemispheres [27,47] or low-frequency rTMS of only intact hemisphere [54]. ...
Rehabilitation of patients with severe traumatic brain injury (sTBI) is a topical medical and social issue because this pathology is one of the main causes of mortality and disability in the young working age population [1]. The most common sTBI consequences include motor and cognitive impairment as well as depression of consciousness [2, 3]. Despite significant progress in treatment of the consequences of severe traumatic brain injury, there are no treatment and rehabilitation standards for these patients, and the used rehabilitation measures are not always effective. These circumstances substantiate the need for the development of additional methods of neurotherapy. Over the past decade, transcranial electrical and magnetic stimulation (TMS) has been increasingly used as neuromodulatory treatment in clinical practice [4-12]. The accumulated experience has shown that transcranial neurostimulation methods require a more individualized approach in terms of both careful selection of patients and choice of exposure parameters. This review is based on an analysis of the most significant publications and recommendations recognized in the scientific community, as well as on reports of domestic and foreign authors presented at dedicated congresses in comparison with experience of our own research on transcranial stimulation. The paper discusses the main problems of using this method in medical practice of sTMI and their possible solutions.
... rTMS is a neuromodulatory technique that induces deep current via magnetic pulses in a safe, noninvasive, and painless way, and can affect brain physiology. Different rTMS techniques have been used to promote stroke rehabilitation (Yozbatiran et al., 2009;Khedr and Fetoh, 2010). The most exciting characteristic of rTMS is that different parameters can produce different modulatory effects. ...
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment that can enhance the recovery of neurological function after stroke. Whether it can similarly promote the recovery of cognitive function after vascular dementia remains unknown. In this study, a rat model for vascular dementia was established by the two-vessel occlusion method. Two days after injury, 30 pulses of rTMS were administered to each cerebral hemisphere at a frequency of 0.5 Hz and a magnetic field intensity of 1.33 T. The Morris water maze test was used to evaluate learning and memory function. The Karnovsky-Roots method was performed to determine the density of cholinergic neurons in the hippocampal CA1 region. Immunohistochemical staining was used to determine the number of brain-derived neurotrophic factor (BDNF)-immunoreactive cells in the hippocampal CA1 region. rTMS treatment for 30 days significantly improved learning and memory function, increased acetylcholinesterase and choline acetyltransferase activity, increased the density of cholinergic neurons, and increased the number of BDNF-immunoreactive cells. These results indicate that rTMS can ameliorate learning and memory deficiencies in rats with vascular dementia. The mechanism through which this occurs might be related to the promotion of BDNF expression and subsequent restoration of cholinergic system activity in hippocampal CA1 region.
... The original search retrieved 26 articles. A study by Khedr et al. [15] found that five daily sessions of rTMS in the esophageal motor cortex of the stroke hemisphere can help patients recover from dysphagia and it is connected with an increase in the excitability of the corticobulbar projection. [14] In the study by Yang et al., [7] there was significant difference between the ipsilesional or contralesional stimulation, although most of the patients restore swallowing capacity within a few weeks [4] while Rofes et al. found that lack of coordination between laryngeal vestibule cohorts and upper esophageal sphincter opening time causes swallowing disorders which leads to a retention of the bolus in the hypopharynx, overflowing the airway. ...
... [3] Through the use of five daily sessions of 1-Hz rTMS for 2 weeks on the esophageal motor area of the affected hemisphere they found that patients who underwent real rTMS on the motor area of the affected hemisphere presented no changes in the unaffected hemisphere while there was an increase in the excitability of the stroke hemisphere. [15] Recently, Jefferson et al. found that 250 pulses of 5-Hz rTMS showed an increase in the pharyngeal motor cortex excitability, which lasted for over 2 h. Active contralateral 5-Hz rTMS completely abolished the cortical suppression caused by the virtual lesion. ...
Various techniques and courses of treatment have been researched, proposed, and implemented to evaluate and treat poststroke dysphagia (PSD) which is one of the main medical conditions affecting not only elderly people, as previously assumed, but also in recent years younger populations as well. The effectiveness of therapeutic methods depends mainly on the expertise of an interdisciplinary team of therapists, as well as on the timely application of the treatment. The present review discusses the therapeutic benefits of repetitive transcranial magnetic stimulation (rTMS) in patients suffering from PSD regardless of the location of the lesion. The use of rTMS directly manipulates cortical brain stimulation to restore neuroplasticity in the affected brain areas. This review presents a synopsis of the available literature on the patient along with a discussion on the effectiveness of rTMS as a safe and easy to use promising technique in the rehabilitation of dysphagic patients. Although the results from the studies so far have been largely positive in that direction, the question still remains whether larger scale and longitudinal studies will be able to corroborate the aspiring future of rTMS. Therefore, research questions to advance further investigation on the application and future of this technique are much in need. © 2018 Journal of Neurosciences in Rural Practice | Published by Wolters Kluwer-Medknow.
... However, inconsistent reports exist regarding the benefits of LF-rTMS: Some studies showed no beneficial effect of LF-rTMS [16,23,29] and one study reported worsening effects of LF-rTMS such as decreased finger-tapping speed; [35] other investigators proposed that inhibition of the contralesional motor areas may lead to deterioration of the function of the unaffected hand [24,26]. Although a few previous meta-analyses had investigated the therapeutic effect of rTMS after stroke [11,[36][37][38], they focused on the mixed effect of combined LF-rTMS and HF-rTMS interventions or on the combined outcomes of varying motor measurements. So far, there is a lack of in-depth systematic meta-analysis about the efficacy of LF-rTMS on upper limb function recovery. ...
Background and Purpose
This meta-analysis aimed to evaluate the therapeutic potential of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the contralesional hemisphere on upper limb motor recovery and cortex plasticity after stroke.
Methods
Databases of PubMed, Medline, ScienceDirect, Cochrane, and Embase were searched for randomized controlled trials published before Jun 31, 2017. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI). Resting motor threshold (rMT) and motor-evoked potential (MEP) were also examined.
Results
Twenty-two studies of 1 Hz LF-rTMS over the contralesional hemisphere were included. Significant efficacy was found on finger flexibility (SMD = 0.75), hand strength (SMD = 0.49), and activity dexterity (SMD = 0.32), but not on body function (SMD = 0.29). The positive changes of rMT (SMD = 0.38 for the affected hemisphere and SMD = −0.83 for the unaffected hemisphere) and MEP (SMD = −1.00 for the affected hemisphere and SMD = 0.57 for the unaffected hemisphere) were also significant.
Conclusions
LF-rTMS as an add-on therapy significantly improved upper limb functional recovery especially the hand after stroke, probably through rebalanced cortical excitability of both hemispheres. Future studies should determine if LF-rTMS alone or in conjunction with practice/training would be more effective.
Clinical Trial Registration Information
This trial is registered with unique identifier CRD42016042181.
... The effectiveness of high-frequency rTMS on motor recovery after acute stroke has been demonstrated by many randomized trials. 19 rTMS can induce neuroplasticity of the ipsilesional M1, strengthen connections between cortical neurons, and briefly increase cerebral blood flow, thereby improving function of the corticospinal tract and facilitating motor rehabilitation. Our study found that compared to the sham group, 5-Hz rTMS applied over the ipsilesional M1 of acute stroke patients could induce more prominent improvement in motor functional scores, such as the NIHSS, BI, FMA-UL. ...
Aims:
To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on motor recovery after stroke using a prospective, double-blind, randomized, sham-controlled study.
Methods:
Patients with unilateral subcortical infarction in the middle cerebral artery territory within 1 week after onset were enrolled. The patients were randomly divided into an rTMS treatment group and a sham group. We performed high-frequency rTMS or sham rTMS on the two groups. Motor functional scores were assessed pre- and post-rTMS/sham rTMS and at 1 month, 3 months, 6 months, and 1 year after stroke onset. The scores included the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Fugl-Meyer Assessment Upper Limb/Lower Limb (FMA-UL/LL), modified Rank Score (mRS), and the resting motor threshold (RMT) of the hemiplegic limb.
Results:
At baseline, no significant differences were found between the two groups for motor functional scores. On the second day after rTMS treatment, score improvements of the NIHSS, BI, FMA-UL in the real treatment group were more significant than those in the sham group. In addition, similar results were obtained at 1 month. However, at 3 months, 6 months, and 1 year after onset, no significant differences in improvement were observed between the two groups, except for the FMA-UL score improvement.
Conclusion:
rTMS facilitates motor recovery of acute stroke patients, and the effect can last to 1 month, except the function improvement on upper extremities could last for 1 year. A single course of rTMS in the acute stage may induce the improvement of upper extremities function lasted for 1 year.
... La rTMS est déjà utilisée pour le traitement de certaines maladies psychiatriques comme la dépression résistante aux traitements médicamenteux ou pour les hallucinations auditives de patients schizophrènes comme le mentionne les premières recommandations canadienne, franç aise, puis européenne sur l'utilisation de la rTMS [11][12][13][14]. Elle a également été étudiée dans certaines maladies neurologiques telles que la maladie de Parkinson et à la phase de rééducation de l'aphasie des accidents cérébraux ischémiques [15,16]. ...
Considering the limited effectiveness of drugs treatments in cognitive disorders, the emergence of noninvasive techniques to modify brain function is very interesting. Among these techniques, repetitive transcranial magnetic stimulation (rTMS) can modulate cortical excitability and have potential therapeutic effects on cognition and behaviour. These effects are due to physiological modifications in the stimulated cortical tissue and their associated circuits, which depend on the parameters of stimulation. The objective of this article is to specify current knowledge and efficacy of rTMS in cognitive disorders. Previous studies found very encouraging results with significant improvement of higher brain functions. Nevertheless, these few studies have limits: a few patients were enrolled, the lack of control of the mechanisms of action by brain imaging, insufficiently formalized technique and variability of cognitive tests. It is therefore necessary to perform more studies, which identify statistical significant improvement and to specify underlying mechanisms of action and the parameters of use of the rTMS to offer rTMS as a routine therapy for cognitive dysfunction.
Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.
