title: Transcranial magnetic stimulation combined with physiotherapy in rehabilitation of poststroke hemiparesis: a randomized, double-blind, placebo-controlled study.
abstract: BACKGROUND
  Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the contralesional primary motor cortex (M1) may improve recovery in patients with hemiparetic stroke.
  
  
  OBJECTIVE
  To evaluate the effectiveness of applying 1 Hz rTMS to the contralesional M1 in addition to physiotherapy during early rehabilitation for stroke patients with hand hemiparesis in a randomized, sham-controlled, double-blind study.
  
  
  METHODS
  Forty patients with moderate upper extremity hemiparesis were randomized to receive 3 weeks of motor training (45 minutes daily) preceded by 30 minutes of 1 Hz rTMS applied to the contralesional M1 or 30 minutes of sham rTMS. Functional assessment of the paretic hand using the Wolf Motor Function Test was performed before, immediately after, and 3 months after completing treatment.
  
  
  RESULTS
  No statistically significant differences were found between the experimental and the control group for hand function (Wolf Motor Function Test; P = .92) or the level of neurological deficit (National Institutes of Health Stroke Scale [NIHSS]; P = .82) after treatment. Effect sizes for the experimental (d = 0.5) and the control group (d = 0.47) were small. Similar results were observed at the 3-month follow-up.
  
  
  CONCLUSIONS
  The findings did not suggest that rTMS suppression of the contralesional motor cortex augments the effect of early neurorehabilitation for upper limb hemiparesis. Larger trials that stratify subjects based on residual motor function or physiological measures of excitation and inhibition may identify responders in the future.
authors.affiliation: Institute of Psychiatry and Neurology, Warsaw, Poland. seniowj@ipin.edu.pl
authors.forename: Joanna
authors.initials: J
authors.lastname: Seniów
authors.forename: Marta
authors.initials: M
authors.lastname: Bilik
authors.forename: Marcin
authors.initials: M
authors.lastname: Leśniak
authors.forename: Konrad
authors.initials: K
authors.lastname: Waldowski
authors.forename: Szczepan
authors.initials: S
authors.lastname: Iwański
authors.forename: Anna
authors.initials: A
authors.lastname: Członkowska
mesh_terms: D000368:Aged; D002540:Cerebral Cortex / Q000503:physiopathology; D003131:Combined Modality Therapy / Q000379:methods*; D003710:Demography; D004311:Double-Blind Method; D005260:Female; D006225:Hand / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology