title: Efficacy of coupling inhibitory and facilitatory repetitive transcranial magnetic stimulation to enhance motor recovery in hemiplegic stroke patients.
abstract: OBJECTIVE
  Although there has been extensive research on the effectiveness of repetitive transcranial magnetic stimulation (rTMS) to improve patients' motor performance after experiencing chronic stroke, explicit findings on the coupling of different rTMS protocols are meager. We designed this sham-controlled randomized study to investigate the potential for a consecutive suppressive-facilitatory TMS protocol to improve motor outcomes after chronic stroke.
  
  
  METHODS
  Fifty-four chronic hemiplegic stroke patients were allocated across 4 groups to undergo 20 daily sessions of (1) 1 Hz rTMS over the contralesional primary motor cortex (M1) and then intermittent theta burst stimulation over the ipsilesional M1 (group A); (2) contralesional sham stimulation and then ipsilesional real intermittent theta burst stimulation (group B); (3) contralesional real 1 Hz rTMS and then ipsilesional sham stimulation (group C); or (4) bilateral sham-control procedures (group D). We tested cortical excitability and motor activity assessments at the baseline, postpriming rTMS, and postconsequent rTMS periods.
  
  
  RESULTS
  At post, group A showed greater muscle strength, Fugl-Meyer Assessment (FMA), Wolf Motor Function test, and reaction time improvement in comparison with group B (P<0.001≈0.003) and group C (P=0.001≈0.003). Correlation analyses in group A revealed a close relation between contralesional map area decrement and Wolf Motor Function test gain (P=0.005; r=-0.75), and also revealed ipsilesional map area increment and reaction time decrement (P=0.02; r=-0.87). We detected no such relations in the other 3 groups.
  
  
  CONCLUSIONS
  Our clinical trials established an extended timeframe during which conditioning could be safely continued and produced more favorable outcomes in facilitating motor performance and ameliorating interhemispheric imbalance than those obtained from single-course rTMS modulation alone.
authors.affiliation: Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wen-Hsu
authors.initials: WH
authors.lastname: Sung
authors.forename: Chih-Pin
authors.initials: CP
authors.lastname: Wang
authors.forename: Chen-Liang
authors.initials: CL
authors.lastname: Chou
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Chen
authors.forename: Yue-Cune
authors.initials: YC
authors.lastname: Chang
authors.forename: Po-Yi
authors.initials: PY
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006429:Hemiplegia / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009048:Motor Skills / Q000502:physiology*; D011930:Reaction Time / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome