Safety of 6-Hz primed low-frequency rTMS in stroke.
BACKGROUND
Suppression of activity in the contralesional motor cortex may promote recovery of function after stroke. Furthermore, the known depressant effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) can be increased and prolonged by preceding it with 6-Hz priming stimulation.


OBJECTIVE
The authors explored the safety of 6-Hz primed low-frequency rTMS in 10 patients with ischemic stroke.


METHODS
Priming consisted of 10 minutes of 6-Hz rTMS applied to the contralesional hemisphere at 90% of resting motor threshold delivered in 2 trains/min with 5 s/train and 25-second intervals between trains. Low-frequency rTMS consisted of an additional 10 minutes of 1-Hz rTMS at 90% of resting motor threshold without interruption. Possible adverse effects were assessed with the National Institutes of Health Stroke Scale (NIHSS), the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), the Hopkins Verbal Learning Test-Revised (HVLT-R), the Beck Depression Inventory-Second Edition (BDI-II), a finger movement tracking test, and individual self-assessments. Pretest, treatment, and posttest occurred on the first day with follow-up tests on the next 5 weekdays.


RESULTS
There were no seizures and no impairment of NIHSS, WAIS-III, or BDI-II scores. Transient impairment occurred on the HVLT-R. Transient tiredness was common. Occasional reports of headache, neck pain, increased sleep, reduced sleep, nausea, and anxiety occurred.


CONCLUSIONS
Because there were no major adverse effects, the authors concluded that the treatment was safe for the individuals in this study and that further investigation is now warranted to examine efficacy and safety of serial treatments of 6-Hz primed low-frequency rTMS.
Carey
James R
JR
Program in Physical Therapy, University of Minnesota, Minneapolis 55455, USA. carey007@umn.edu
Evans
Chad D
CD
Anderson
David C
DC
Bhatt
Ela
E
Nagpal
Ashima
A
Kimberley
Teresa J
TJ
Pascual-Leone
Alvaro
A
D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D003337:Corpus Callosum / Q000503:physiopathology; D004525:Efferent Pathways / Q000503:physiopathology; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009046:Motor Neurons / Q000502:physiology; D009433:Neural Inhibition / Q000502:physiology; D009434:Neural Pathways / Q000503:physiopathology; D009483:Neuropsychological Tests; D010291:Paresis / Q000503:physiopathology / Q000628:therapy*; D012640:Seizures / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome