Objectives: To Test the hypothesis that 10 days of high frequency (10HZ) repetitive transcranial magnetic stimulation (rTMS) with hand therapy elicit more improvement on motor recovery and motor function in the paretic hand than sham stimulation in patients with stroke and to examine the correlation between corticomotor excitability and motor function of the hand in stroke subjects at various time points of recovery.
Method: Forty normal control subjects were recruited to record MEP variables of APB muscle of both sides and compare it with 60 acute stroke subjects.60 stroke subjects were randomly assigned to one of the two treatment methods. The rTMS group received high frequency (10Hz) rTMS to the affected hemisphere plus hand therapy for the hemi paretic hand and in sham rTMS group, patients received sham stimulation to the affected hemisphere and hand therapy to the hemi paretic hand. Corticomotor excitability was assessed by the central motor conduction time(CMCT) and motor threshold at baseline, after 5 days and 10 days following intervention. Motor function of the hand was assessed by the Jebsen hand function test(JHFT) at baseline, after 5 days and 10 days of intervention.
Results: Normative values of APB was analyzed with ROC curve and compared with stroke subjects.. Patients with rTMS group receiving 10 Hz rTMS plus hand therapy lead to a greater improvement in corticomotor excitability. Corticomotor excitability decreased and motor function of the hand improved following intervention (P=0.001). There was a significant correlation between the Corticomotor excitability and motor function of the hand in the affected hemisphere at various time points of recovery.
Conculsions: Focal stimulation of high frequency (10 Hz) rTMS to the affected motor cortex and 30 min of motor training twice a day for 10 consecutive days would enhance the Corticomotor excitability and improved motor function of the affected hand in stroke subjects.
via Indian Journals.