title: Combination treatment of low-frequency rTMS and occupational therapy with levodopa administration: an intensive neurorehabilitative approach for upper limb hemiparesis after stroke.
abstract: The combination treatment of low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy was applied with concomitant oral administration of levodopa in five post-stroke patients with upper limb hemiparesis (age at treatment: 56-66 years; interval between onset of stroke and treatment: 18-143 months) as a 15-day inpatient protocol. Daily levodopa administration of 100 mg was initiated 1 week before admission and continued until 4 weeks after discharge. Low-frequency rTMS of 1 Hz was applied to the contralesional hemisphere for 40 min daily (two 20-min sessions) combined with intensive occupational therapy consisting of 60-min one-on-one training and 60-min self-exercise. Motor function of the affected upper limb was serially evaluated with the Fugl-Meyer Assessment and the Wolf Motor Function Test. At the end of the treatment, all patients showed improved motor function in the affected upper limbs. In some patients, the improvement was maintained until 4 weeks after discharge. No patient showed any adverse effect from the intervention. Our proposed protocol featuring levodopa administration, low-frequency rTMS, and intensive occupational therapy could provide a safe and feasible intervention for upper limb hemiparesis after stroke.
authors.affiliation: Department of Rehabilitation Medicine, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo 105-8461, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Kakuda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Abo
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Ryo
authors.initials: R
authors.lastname: Momosaki
authors.forename: Aki
authors.initials: A
authors.lastname: Yokoi
authors.forename: Akiko
authors.initials: A
authors.lastname: Fukuda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Ayumi
authors.initials: A
authors.lastname: Tominaga
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000534:rehabilitation; D009483:Neuropsychological Tests; D009788:Occupational Therapy; D010291:Paresis / Q000188:drug therapy / Q000534:rehabilitation*; D010865:Pilot Projects; D011597:Psychomotor Performance / Q000502:physiology; D020127:Recovery of Function; D020521:Stroke / Q000188:drug therapy; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D034941:Upper Extremity
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa