Objective To investigate the effect of low frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) on balance impairment in patients with cerebral infarction.
Methods Thirty-two patients were randomly divided into two groups: rTMS group (n=16) and control (n=16). In the rTMS group, treatment was performed five times per week for 2 weeks (10 sessions), and in the control group, a sham coil was used with the sound and sensation of scalp similar to the rTMS coil. Patients in both groups underwent a conventional rehabilitation program. Berg Balance Scale (BBS) was used as the primary outcome measurement. Timed Up and Go test (TUG), 10-m walk test (10mWT), and Activity-specific Balance Confidence scale (ABC) were used as the secondary outcome measurement. All scales were measured at baseline (T0), after 10 sessions of rTMS (T1), and at 4 weeks after treatment completion (T2) by therapists with over 5 years of clinical experience.
Results There were significant improvements between T0 and T1, and between T0 and T2, for all assessed items in the rTMS group. Whereas there were significant improvements between T0 and T1, and between T0 and T2, for the BBS and 10mWT in the control group. TUG (-4.87±5.05 vs. -0.50±2.97 seconds) and ABC score (8.10±8.33 vs. 0.16±0.97) were observed significant differences in comparison of the changes from T0 to T1 between the two group. BBS score (4.40±3.66 vs. 1.88±3.14), TUG (-4.87±4.56 vs. -0.62±2.96 seconds) and ABC score (8.22±7.70 vs. -0.09±0.86) differed significantly from T0 to T2 between the two groups.
Conclusion Our findings suggest that low-frequency cerebellar rTMS is helpful for improving balance in patients with cerebral infarction, and maybe a beneficial treatment for these patients.
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Objective To compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on upper limb function recovery among patients who recently had stroke.
Methods Subjects with recent stroke (within 1 month) were randomized to rTMS (n=25) and tDCS (n=26) applied over the non-lesioned hemisphere for three sessions per week, followed by tailored upper limb rehabilitation training for a total of 2 weeks. The primary outcomes were changes in the Motor Assessment Scale (MAS), Fugl-Meyer arm score test, Nine-Hole Peg Test (9HPT), hand grip strength, and modified Barthel Index at weeks 2 and 4. Both therapists responsible for training and assessment were blinded to the intervention allocated.
Results There was an improvement in all the motor performance scales among both groups (p<0.001). These improvements persisted at discharge. However, there was no significant difference in any of the assessment scales between the two groups. The rTMS group showed a statistically non-significant greater improvement in MAS, 9HPT, and handgrip strength than the tDCS group.
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Objective To investigate the effects of high frequency (10 Hz) repetitive transcranial magnetic stimulation (rTMS) on visuospatial motor learning, stimulated on the premotor cortex in basal ganglia hemorrhage patients. Method Nine patients were randomized to receive real and sham rTMS. We subdivided into two groups according to the integrity of the corticospinal tract measured by diffusion tensor tractography. The implicit visuospatial learning paradigm composed of numbers 1 to 4, in which 12 sequential numbers (2-3-1-4-3-2-4-1-3-4-2-1) were incorporated randomly. We obtained the mean fraction anisotrophy (FA) and apparent diffusion coefficient (ADC) values from the corticospinal tract and subdividing into two groups by calculating the relative value (laterality %). Results rTMS on the premotor cortex was effective only in simple motor learning but not in visuospatial learning in group analysis. The primary motor cortex excitability after the premotor cortex stimulation has been changed significantly. Subdividing into two groups according to the integrity of the corticospinal tract using the ADC value, the low ADC value group showed significant reduction of the visuospatial response time. Conclusion High frequency rTMS on the premotor cortex was effective in simple motor learning and also in the group who maintained more integrity of the corticospinal tract in basal ganglia hemorrhage.
Objective To investigate the effects of continuous repetitive transcranial magnetic stimulation (rTMS) on pain response in spinal cord injured rat. Method: Forty Sprague-Dawley rats (200∼250 grams, female) were used. Thoracic spinal cord (T9) was contused using New York University (NYU) spinal cord impactor. Ten gram weight rod was dropped from a height of 25 mm to produce spinal cord contusion model with moderate injury. The animals were randomly assigned to two groups: one exposed to real magnetic stimulation (real-rTMS group) and the other not exposed to magnetic stimulation (sham- rTMS group). rTMS was applied for 8 weeks. To assess the effect of continuous rTMS on below-level pain responses after spinal cord injury (SCI), the hindpaw withdrawal response for thermal stimuli, cold stimuli and mechanical stimuli were compared between two groups. Results: Behavioral response for pain showed that hindpaw withdrawal response for cold stimuli was reduced significantly from 4 weeks after SCI in real-rTMS group compared with sham group (p＜0.05). Conclusion: These results suggest that continuous rTMS may have beneficial effects on attenuation of cold allodynia after SCI, and it might be an additional non-invasive therapeutic method in patients with chronic neuropathic pain after SCI. (J Korean Acad Rehab Med 2010; 34: 259-264)
Objective: To investigate the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex on sensory and pain perception. Method: We measured the current perception threshold and the pain tolerance threshold with NeurometerⰒ CPT/C in 14 healthy subjects (eleven males and three females, mean age: 25.0 years). Threshold testing was evaluated prior to, immediately after, 30 min after and 60 min after rTMS. The stimulation parameters were a frequency of 10 Hz and a field intensity of 100% of the active motor thresholds. Stimuli were provided in trains of 100 pulses, followed by a 50s rest period, 10 trains were applied in the session, resulting in 1,000 pulses in total. Results: The current perception thresholds of 5, 250, 2,000 Hz were significantly increased immediately, 30 min after rTMS (p＜0.05) and no effects at all were noticed after sham rTMS. The pain tolerance thresholds of 5, 250 Hz were significantly increased immediately, 30 min after rTMS and the pain tolerance threshold of 2,000 Hz were significantly increased immediately, 30 min, 60 min after rTMS (p＜ 0.05). No effects at all were noticed after sham rTMS. Conclusion: After high frequency rTMS over the primary motor cortex, we found that the current perception thresholds and the pain tolerance thresholds of 5, 250, 2,000 Hz were significantly increased. (J Korean Acad Rehab Med 2008; 32: 506-511)
Objective To investigate whether suppression of right inferior frontal gyrus (Broca's homologue) by 1 Hz repetitive transcranial magnetic stimulation (rTMS) can improve speech recovery. Method: We applied low frequency rTMS on right Broca's homologue twice a week for 6 weeks in eight subcortical aphasia patients who were 3 months to 3 years poststroke onset. They were tested with Korean Version-Western Aphasia Battery before and after procedure. Also, they were tested with Parallel Short Forms for the Korean-Boston Naming Test and Animal Naming Test serially for outcome measure. rTMS was performed with intensity of 80% of motor threshold for 10 min (600 pulses) at 1 Hz frequency. Results: Significant improvement was observed in picture naming at post-rTMS only in nonfluent aphasia patients but not in fluent aphasia patients. Conclusion: rTMS may provide a novel treatment for aphasia by possibly modulating the distributed, bi-hemispheric language network. (J Korean Acad Rehab Med 2007; 31: 70-77)
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