Deep Repetitive Transcranial Magnetic Stimulation With H-coil on Lower Limb Motor Function in Chronic Stroke: A Pilot Study

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• 作者：Raffaella Chieffo ; MD^a ; Serena De Prezzo ; MD^a ; Elise Houdayer ; PhD^a ; Arturo Nuara ; MD^a ; Giovanni Di Maggio ; MD^a ; Elisabetta Coppi ; MD^a ; Laura Ferrari ; MD^a ; Laura Straffi ; MD^a ; Francesca Spagnolo ; MD^a ; Svetla Velikova ; MD ; PhD^a ; Maria Sessa ; MD^a ; Mauro Comola ; MD^a ; Abraham Zangen ; PhD^b ; Giancarlo Comi ; MD^a ; Letizia Leocani ; MD ; PhD^a ; ^{letizia.leocani@hsr.it" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Lower limb ; Rehabilitation ; Stroke ; Transcranial magnetic stimulation ; repetitive
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：95
• 期：6
• 页码：1141-1147
• 全文大小：443 K

文摘

To assess the efficacy of high-frequency (20Hz) brain stimulation on lower limb motor function in subjects with chronic (>6mo) subcortical stroke.

Design

Double-blind, placebo-controlled crossover study.

Setting

University hospital.

Participants

Right-handed subjects (N=10) affected by a first-ever subcortical stroke in the territory of the middle cerebral artery were included in this study.

Interventions

Repetitive transcranial magnetic stimulation (rTMS) was delivered with the H-coil, specifically designed to target deeper and larger brains regions. Each subject received both real and sham rTMS in a random sequence. The 2 rTMS cycles (real or sham) were composed of 11 sessions each, administered over 3 weeks and separated by a 4-week washout period.

Main Outcome Measures

Lower limb functions were assessed by the lower limb Fugl-Meyer scale, the 10-m walk test, and the 6-minute walk test before and 1 day after the end of each treatment period, as well as at a 4-week follow-up.

Results

Real rTMS treatment was associated with a significant improvement in lower limb motor function. This effect persisted over time (follow-up) and was significantly greater than that observed with sham stimulation. A significant increase in walking speed was also found after real rTMS, but this effect did not reach statistical significance in comparison with the sham stimulation.

Conclusions

These data demonstrated that 3 weeks of high-frequency deep rTMS could induce long-term improvements in lower limb functions in the chronic poststroke period, lasting at least 1 month after the end of the treatment.