title: A pilot study on the effects of low frequency repetitive transcranial magnetic stimulation on lower extremity spasticity and motor neuron excitability in patients after stroke.
abstract: OBJECTIVE
  To evaluate the effect of low frequency, repetitive transcranial magnetic stimulation (rTMS) on the lower extremity spasticity and motor neuron excitability in patients after stroke.
  
  
  METHODS
  Seven patients after stroke aged 42-78 years were included in this pretest-posttest clinical trial. The rTMS at 1 Hz and duration of 20 min was applied to the intact leg motor cortex for five consecutive sessions. Primary outcome measures were the Modified Modified Ashwoth Scale (MMAS) and the H(max)/M(max) ratio. Measurements were taken at baseline (T0), after the last treatment (5th) session (T1), and at 1 week follow up (T2).
  
  
  RESULTS
  Clinically assessed ankle plantar flexor spasticity (p = 0.05) improved significantly after treatment at T1. Knee extensor spasticity scored 0 after treatment at T1 and T2. The H(max)/M(max) ratio showed no statistically significant improvement after treatment.
  
  
  CONCLUSIONS
  The pilot data indicate that the inhibitory rTMS of the intact leg motor cortex in patients after stroke may improve the lower extremity spasticity.
authors.affiliation: Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: naghdi@sina.tums.ac.ir.
authors.forename: Soofia
authors.initials: S
authors.lastname: Naghdi
authors.affiliation: Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Noureddin Nakhostin
authors.initials: NN
authors.lastname: Ansari
authors.affiliation: Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Rastgoo
authors.affiliation: Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Bijan
authors.initials: B
authors.lastname: Forogh
authors.affiliation: Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shohreh
authors.initials: S
authors.lastname: Jalaie
authors.affiliation: Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Olyaei
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology; D009128:Muscle Spasticity / Q000209:etiology* / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D020521:Stroke / Q000150:complications*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: Function; H-reflex; Spasticity; Stroke; Therapy; rTMS