title: Inhibitory repetitive transcranial magnetic stimulation of the contralesional premotor and primary motor cortices facilitate poststroke motor recovery.
abstract: OBJECTIVE
  The premotor cortex plays a major role in motor planning and control, exhibiting hierarchical importance comparable to that of the primary motor cortex (M1). In this study, we compared the effects of cPMd modulation, which was achieved using inhibitory repetitive transcranial magnetic stimulation (rTMS), with those of contralesional M1 (cM1) modulation, to elucidate the roles of both regions on longitudinal motor recovery following a stroke.
  
  
  METHODS
  Forty-four patients who had sustained hemiplegia for 3 to 12 months were randomly allocated to a cPMd group, cM1 group, or sham group and received 10 sessions of 1-Hz rTMS. The Medical Research Council (MRC) Scale, Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), and a cortical excitability test were administered pre- and post- rTMS intervention.
  
  
  RESULTS
  cPMd modulation yielded significant improvements in MRC, FMA, and WMFT scores compared with sham stimulation and a significant effect on cortical excitability suppression equivalent to that of cM1 modulation, but engendered effects on motor improvement inferior to those of cM1 modulation.
  
  
  CONCLUSIONS
  In patients with chronic stroke, the cPMd can fulfill a role similar to that of the cM1 in interhemispheric imbalance, which can be ameliorated by applying inhibitory rTMS to achieve substantial motor restoration.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chien-Chih
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Department of Emergency, Mackay Memorial Hospital, Taipei, Taiwan Department of Medicine, Mackay Medical College, Taipei, Taiwan.
authors.forename: Chih-Pin
authors.initials: CP
authors.lastname: Wang
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Po-Yi
authors.initials: PY
authors.lastname: Tsai
authors.affiliation: Department of Emergency, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chin-Yi
authors.initials: CY
authors.lastname: Hsieh
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Rai-Chi
authors.initials: RC
authors.lastname: Chan
authors.affiliation: Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan.
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Yeh
mesh_terms: D000368:Aged; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009048:Motor Skills / Q000502:physiology*; D009433:Neural Inhibition / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012720:Severity of Illness Index; D020521:Stroke / Q000503:physiopathology* / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Repetitive transcranial magnetic stimulation (rTMS); dorsal premotor cortex (PMd); motor recovery; neuromodulation; primary motor cortex (M1); stroke