title: Deep repetitive transcranial magnetic stimulation with H-coil on lower limb motor function in chronic stroke: a pilot study.
abstract: OBJECTIVE
  To assess the efficacy of high-frequency (20 Hz) brain stimulation on lower limb motor function in subjects with chronic (> 6 mo) subcortical stroke.
  
  
  METHODS
  Double-blind, placebo-controlled crossover study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Right-handed subjects (N=10) affected by a first-ever subcortical stroke in the territory of the middle cerebral artery were included in this study.
  
  
  METHODS
  Repetitive transcranial magnetic stimulation (rTMS) was delivered with the H-coil, specifically designed to target deeper and larger brains regions. Each subject received both real and sham rTMS in a random sequence. The 2 rTMS cycles (real or sham) were composed of 11 sessions each, administered over 3 weeks and separated by a 4-week washout period.
  
  
  METHODS
  Lower limb functions were assessed by the lower limb Fugl-Meyer scale, the 10-m walk test, and the 6-minute walk test before and 1 day after the end of each treatment period, as well as at a 4-week follow-up.
  
  
  RESULTS
  Real rTMS treatment was associated with a significant improvement in lower limb motor function. This effect persisted over time (follow-up) and was significantly greater than that observed with sham stimulation. A significant increase in walking speed was also found after real rTMS, but this effect did not reach statistical significance in comparison with the sham stimulation.
  
  
  CONCLUSIONS
  These data demonstrated that 3 weeks of high-frequency deep rTMS could induce long-term improvements in lower limb functions in the chronic poststroke period, lasting at least 1 month after the end of the treatment.
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Chieffo
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: De Prezzo
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Elise
authors.initials: E
authors.lastname: Houdayer
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Arturo
authors.initials: A
authors.lastname: Nuara
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Maggio
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Coppi
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Ferrari
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Straffi
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Spagnolo
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Svetla
authors.initials: S
authors.lastname: Velikova
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Sessa
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Comola
authors.affiliation: Department of Life Sciences, Ben-Gurion University, Beer-Sheva, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Zangen
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Comi
authors.affiliation: Scientific Institute Vita-Salute University San Raffaele, Neurological Department, Experimental Neurophysiology Unit, INSPE-Institute of Experimental Neurology, Milan, Italy. Electronic address: letizia.leocani@hsr.it.
authors.forename: Letizia
authors.initials: L
authors.lastname: Leocani
mesh_terms: D000704:Analysis of Variance; D002908:Chronic Disease; D018592:Cross-Over Studies; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D009048:Motor Skills / Q000502:physiology*; D010865:Pilot Projects; D020127:Recovery of Function; D012016:Reference Values; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
keywords: Lower limb; Rehabilitation; Stroke; Transcranial magnetic stimulation, repetitive