title: Benefits of repetitive transcranial magnetic stimulation (rTMS) for spastic subjects: clinical, functional, and biomechanical parameters for lower limb and walking in five hemiparetic patients.
abstract: Introduction. Spasticity is a disabling symptom resulting from reorganization of spinal reflexes no longer inhibited by supraspinal control. Several studies have demonstrated interest in repetitive transcranial magnetic stimulation in spastic patients. We conducted a prospective, randomized, double-blind crossover study on five spastic hemiparetic patients to determine whether this type of stimulation of the premotor cortex can provide a clinical benefit. Material and Methods. Two stimulation frequencies (1 Hz and 10 Hz) were tested versus placebo. Patients were assessed clinically, by quantitative analysis of walking and measurement of neuromechanical parameters (H and T reflexes, musculoarticular stiffness of the ankle). Results. No change was observed after placebo and 10 Hz protocols. Clinical parameters were not significantly modified after 1 Hz stimulation, apart from a tendency towards improved recruitment of antagonist muscles on the Fügl-Meyer scale. Only cadence and recurvatum were significantly modified on quantitative analysis of walking. Neuromechanical parameters were modified with significant decreases in H max⁡ /M max⁡ and T/M max⁡ ratios and stiffness indices 9 days or 31 days after initiation of TMS. Conclusion. This preliminary study supports the efficacy of low-frequency TMS to reduce reflex excitability and stiffness of ankle plantar flexors, while clinical signs of spasticity were not significantly modified.
authors.affiliation: Department of Neurosurgery and Neurotraumatology, CHU de Nantes, 1, place Alexis Ricordeau, 44093 Nantes, France ; UMR CNRS 7338 Biomécanique et Bioingénierie, Université de Technologies de Compiègne, BP 20529, 60205 Compiègne, France.
authors.forename: Luc
authors.identifier: 0000-0002-6993-5643
authors.initials: L
authors.lastname: Terreaux
authors.affiliation: Movement Analysis Laboratory, Department of Physical Medicine and Rehabilitation, Hôpital Saint Jacques, CHU Nantes, 1, place Alexis Ricordeau, 44093 Nantes, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Gross
authors.affiliation: Movement Analysis Laboratory, Department of Physical Medicine and Rehabilitation, Hôpital Saint Jacques, CHU Nantes, 1, place Alexis Ricordeau, 44093 Nantes, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Leboeuf
authors.affiliation: Department of Neuroradiology, CHU de Nantes, 1, place Alexis Ricordeau, 44093 Nantes, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Desal
authors.affiliation: Department of Neurosurgery and Neurotraumatology, CHU de Nantes, 1, place Alexis Ricordeau, 44093 Nantes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hamel
authors.affiliation: Department of Neurosurgery and Neurotraumatology, CHU de Nantes, 1, place Alexis Ricordeau, 44093 Nantes, France ; INSERM EA3826, "Pain, Neuromodulation, and Quality of Life", CHU de Nantes, 1, place Alexis Ricordeau, 44093 Nantes, France.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Nguyen
authors.affiliation: UMR CNRS 7338 Biomécanique et Bioingénierie, Université de Technologies de Compiègne, BP 20529, 60205 Compiègne, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Pérot
authors.affiliation: Department of Neurosurgery and Neurotraumatology, CHU de Nantes, 1, place Alexis Ricordeau, 44093 Nantes, France ; UMR CNRS 7338 Biomécanique et Bioingénierie, Université de Technologies de Compiègne, BP 20529, 60205 Compiègne, France ; INSERM EA3826, "Pain, Neuromodulation, and Quality of Life", CHU de Nantes, 1, place Alexis Ricordeau, 44093 Nantes, France.
authors.forename: Kévin
authors.initials: K
authors.lastname: Buffenoir
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D004311:Double-Blind Method; D006801:Humans; D007866:Leg / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology / Q000628:therapy*; D010291:Paresis / Q000503:physiopathology / Q000628:therapy*; D065908:Transcranial Direct Current Stimulation / Q000379:methods; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*