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Cortical and spinal excitability changes after repetitive transcranial magnetic stimulation combined to physiotherapy in stroke spastic patients

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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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Authors and Affiliations

  1. Applied Neuroscience Laboratory, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil

    Rebeka Borba Costa dos Santos, Silvana Carla Barros Galvão, Labibe Mara Pinel Frederico, Nathália Serrano Lucena Amaral, Maíra Izzadora Souza Carneiro & Kátia Monte-Silva

  2. Laboratory of Kinesiology and Functional Assessment, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil

    Alberto Galvão de Moura Filho

  3. School of Physical and Occupational Therapy, McGill University, Montreal, Canada

    Daniele Piscitelli

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  1. Rebeka Borba Costa dos Santos
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  2. Silvana Carla Barros Galvão
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Correspondence to Kátia Monte-Silva.

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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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