Differential Effect of Conditioning Sequences in Coupling Inhibitory/Facilitatory Repetitive Transcranial Magnetic Stimulation for PostStroke Motor Recovery. (15th January 2014)

• Record Type: Journal Article
• Authors: Wang, Chih‐Pin; Tsai, Po‐Yi; Yang, Tsui Fen; Yang, Kuang‐Yao; Wang, Chien‐Chih
• Is Part Of: CNS neuroscience & therapeutics. Volume 20:Number 4(2014)
• Page Start: 355
• Page End: 363
• Publication Date: 2014-01-15
• Subjects: Neuropharmacology -- Periodicals; Central nervous system -- Diseases -- Effect of drugs on -- Periodicals; 612.8
• DOI: 10.1111/cns.12221
• Languages: English
• ISSNs: 1755-5930

Abstract

<abstract abstract-type="main" id="cns12221-abs-0001"> <title>Summary</title> <sec id="cns12221-sec-0001" sec-type="section"> <title>Introduction</title> <p>While neuromodulation through unihemispheric repetitive transcranial magnetic stimulation (rTMS) has shown promise for the motor recovery of stroke patients, the effectiveness of the coupling of different rTMS protocols remains unclear.</p> </sec> <sec id="cns12221-sec-0002" sec-type="section"> <title>Aims</title> <p>We aimed to test the long‐term efficacy of this strategy with different applying sequences and to identify the electrophysiological correlates of motor improvements to the paretic hand.</p> </sec> <sec id="cns12221-sec-0003" sec-type="section"> <title>Results</title> <p>In our sham‐controlled, double‐blinded parallel study, 48 stroke patients (2–6 months poststroke) were randomly allocated to three groups. Group A underwent 20‐session rTMS conditioning initiated with 10‐session 1 Hz rTMS over the contralesional primary motor cortex (M1), followed by 10‐session intermittent theta burst stimulation (iTBS) consequently over the ipsilesional M1; Group B underwent the same two paradigms but in reverse; and Group C received sham stimulation that was identical to Group A. We tested cortical excitability and motor assessments at the baseline, postpriming rTMS, postconsequent rTMS, and at 3‐months follow‐up. Group A manifested greater improvement than Group B in Fugl‐Meyer Assessment (FMA), Wolf Motor Function testing (WMFT) score, and muscle strength (<italic>P</italic> = 0.001–0.02) post the priming rTMS. After the consequent rTMS, Group A continued to present a superior outcome than Group B in FMA (<italic>P</italic> = 0.015) and WMFT score (<italic>P</italic> = 0.008) with significant behavior‐electrophysiological correlation.</p> </sec> <sec id="cns12221-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Conditioning the contralesional M1 prior to ipsilesional iTBS was found to be optimal for enhancing hand function, and this effect persisted for at least 3 months. Early modulation within 6 months poststroke rebalances interhemispheric competition and appears to be a feasible time window for rTMS intervention.</p> </sec> </abstract>