Safety and behavioral effects of high-frequency repetitive transcranial magnetic stimulation in stroke.
OBJECTIVE
Electromagnetic brain stimulation might have value to reduce motor deficits after stroke. Safety and behavioral effects of higher frequencies of repetitive transcranial magnetic stimulation (rTMS) require detailed assessment.


METHODS
Using an active treatment-only, unblinded, 2-center study design, patients with chronic stroke received 20 minutes of 20 Hz rTMS to the ipsilesional primary motor cortex hand area. Patients were assessed before, during the hour after, and 1 week after rTMS.


RESULTS
The 12 patients were 4.7+/-4.9 years poststroke (mean+/-SD) with moderate-severe arm motor deficits. In terms of safety, rTMS was well tolerated and did not cause new symptoms; systolic blood pressure increased from pre- to immediately post-rTMS by 7 mm Hg (P=0.043); and none of the behavioral measures showed a decrement. In terms of behavioral effects, modest improvements were seen, for example, in grip strength, range of motion, and pegboard performance, up to 1 week after rTMS. The strongest predictor of these motor gains was lower patient age.


CONCLUSIONS
A single session of high-frequency rTMS to the motor cortex was safe. These results require verification with addition of a placebo group and thus blinded assessments across a wide spectrum of poststroke deficits and with larger doses of 20 Hz rTMS.
Nuray
N
Yozbatiran
Miguel
M
Alonso-Alonso
Jill
J
See
Asli
A
Demirtas-Tatlidede
Daniel
D
Luu
Rehan R
RR
Motiwala
Alvaro
A
Pascual-Leone
Steven C
SC
Cramer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000294:innervation / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology / Q000528:radiation effects; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000098:blood supply / Q000503:physiopathology / Q000528:radiation effects; D009048:Motor Skills / Q000502:physiology / Q000528:radiation effects; D009069:Movement Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D053580:Muscle Strength / Q000502:physiology / Q000528:radiation effects; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020521:Stroke / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult