Abstract
Objective
Repetitive Transcranial Magnetic Stimulation (rTMS) has been used to treat post-stroke upper limb spasticity (ULS) in addition to physiotherapy (PT). To determine whether rTMS associated with PT modulates cortical and spinal cord excitability as well as decreases ULS of post-stroke patients.
Methods
Twenty chronic patients were randomly assigned to either the intervention group-1 Hz rTMS on the unaffected hemisphere and PT, or control group-sham stimulation and PT, for ten sessions. Before and after sessions, ULS was measured using the modified Ashworth scale and cortical excitability using the output intensity of the magnetic stimulator (MSO). The spinal excitability was measured by the Hmax/Mmax ratio of the median nerve at baseline, at the end of treatment, and at the 4-week follow-up.
Results
The experimental group showed at the end of treatment an enhancement of cortical excitability, i.e., lower values of MSO, compared to control group (p = 0.044) and to baseline (p = 0.028). The experimental group showed a decreased spinal cord excitability at the 4-week follow-up compared to control group (p = 0.021). ULS decreased by the sixth session in the experimental group (p < 0.05).
Conclusion
One-hertz rTMS associated with PT increased the unaffected hemisphere excitability, decreased spinal excitability, and reduced post-stroke ULS.
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Abbreviations
- rTMS:
-
repetitive transcranial magnetic stimulation
- ULS:
-
upper limb spasticity
- PT:
-
physical therapy
- MSO:
-
magnetic stimulator output
- CT:
-
computed tomography
- MRI:
-
magnetic resonance imaging
- MAS:
-
modified ashworth scale
- MEP:
-
motor-evoked potential
- MT:
-
motor threshold
- EMG:
-
electromyography
- H-reflex:
-
Hoffmann reflex
- Hmax:
-
maximum amplitude of the H-wave
- Mmax:
-
maximum amplitude of the M-wave
- FDI:
-
first dorsal interosseous
- RCT:
-
randomized clinical trial
- SPSS:
-
statistical package for social sciences
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Funding
KMS is supported by CNPQ-Brazil (grant number 308291/2015-8) and the research was supported by grant (number APQ-0357-4.08/13) from Fundação de Amparo a Ciência e Tecnologia do Estado de Pernambuco (FACEPE)-Recife-Brazil.
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dos Santos, R.B.C., Galvão, S.C.B., Frederico, L.M.P. et al. Cortical and spinal excitability changes after repetitive transcranial magnetic stimulation combined to physiotherapy in stroke spastic patients. Neurol Sci 40, 1199–1207 (2019). https://doi.org/10.1007/s10072-019-03765-y
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DOI: https://doi.org/10.1007/s10072-019-03765-y