title: Corticospinal integrity and motor impairment predict outcomes after excitatory repetitive transcranial magnetic stimulation: a preliminary study.
abstract: OBJECTIVE
  To identify the effective predictors for therapeutic outcomes based on intermittent theta-burst stimulation (iTBS).
  
  
  METHODS
  A sham-controlled, double-blind parallel study design.
  
  
  METHODS
  A tertiary hospital.
  
  
  METHODS
  People with stroke (N=72) who presented with unilateral hemiplegia.
  
  
  METHODS
  Ten consecutive sessions of real or sham iTBS were implemented with the aim of enhancing hand function. Patients were categorized into 4 groups according to the presence (MEP+) or absence (MEP-) of motor-evoked potentials (MEPs) and grip strength according to the Medical Research Council (MRC) scale.
  
  
  METHODS
  Cortical excitability, Wolf Motor Function Test (WMFT), finger-tapping task (FT), and simple reaction time were performed before and after the sessions.
  
  
  RESULTS
  MEPs and the MRC scale were predictive of iTBS therapeutic outcomes. Group A (MEP+, MRC>1) exhibited the greatest WMFT change (7.6±2.3, P<.001), followed by group B (MEP-, MRC>1; 5.2±2.2 score change) and group C (MEP-, MRC=0; 2.3±1.5 score change). These improvements were correlated significantly with baseline motor function and ipsilesional maximum MEP amplitude.
  
  
  CONCLUSIONS
  The effectiveness of iTBS modulation for poststroke motor enhancement depends on baseline hand grip strength and the presence of MEPs. Our findings indicate that establishing neurostimulation strategies based on the proposed electrophysiological and clinical criteria can allow iTBS to be executed with substantial precision. Effective neuromodulatory strategies can be formulated by using electrophysiological features and clinical presentation information as guidelines.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Chih-Jou
authors.initials: CJ
authors.lastname: Lai
authors.affiliation: Department of Emergency, Mackay Memorial Hospital, 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; National Yang-Ming University, School of Medicine, Taipei, Taiwan. Electronic address: pytsai@vghtpe.gov.tw.
authors.forename: Po-Yi
authors.initials: PY
authors.lastname: Tsai
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Rai-Chi
authors.initials: RC
authors.lastname: Chan
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shan-Hui
authors.initials: SH
authors.lastname: Lin
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Fu-Gong
authors.initials: FG
authors.lastname: Lin
authors.affiliation: Department of Emergency, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chin-Yi
authors.initials: CY
authors.lastname: Hsieh
mesh_terms: D000368:Aged; D002525:Cerebellar Cortex / Q000503:physiopathology*; D004311:Double-Blind Method; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D007839:Functional Laterality; D018737:Hand Strength / Q000502:physiology*; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008875:Middle Aged; D020127:Recovery of Function; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D062606:Tertiary Care Centers; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: Motor cortex; Prognosis; Rehabilitation; Stroke; Transcranial magnetic stimulation