title: Daily Repetitive Transcranial Magnetic Stimulation for Poststroke Upper Limb Paresis in the Subacute Period.
abstract: BACKGROUND
  We conducted a randomized, double-blind, sham-controlled study to assess the efficacy in motor recovery and safety of daily repetitive transcranial magnetic stimulation (rTMS) in subacute stroke patients.
  
  
  METHODS
  Forty-one patients were randomly assigned to a real or sham stimulation group. Each patient underwent regular rehabilitation accompanied by a series of 10 daily 5-Hz rTMS of the ipsilesional primary motor cortex (M1) or sham stimulation. The primary outcome was motor recovery evaluated by the Brunnstrom stages (BS). The secondary outcomes were improvement in the Fugl-Meyer Assessment (FMA), grip power, National Institutes of Health Stroke Scale (NIHSS), Functional Independence Measure (FIM), a quantitative measurement of finger tapping movement, and the incidence of adverse events.
  
  
  RESULTS
  Thirty-nine patients completed the study and were included in the analyses. The real rTMS group demonstrated additional improvement in the BS hand score at the last follow-up compared to the sham. The grip power, the NIHSS motor score, and the number of finger taps in the affected hand improved in the real stimulation group but not in the sham group. The BS upper limb scores, the FMA distal upper limb score, the NIHSS total score, and the FIM motor score showed improvement from baseline at the earlier time points after the real rTMS. There were no additional improvements in the other scores after the real rTMS compared to the sham. No serious adverse events were observed.
  
  
  CONCLUSIONS
  Our results suggest that dailyhigh-frequency rTMS of the ipsilesional M1 is tolerable and modestly facilitates motor recovery in the paralytic hand of subacute stroke patients.
authors.affiliation: Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hosomi
authors.affiliation: Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Shayne
authors.initials: S
authors.lastname: Morris
authors.affiliation: Kansai Rehabilitation Hospital, Osaka, Japan.
authors.forename: Tomosaburo
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Takarazuka Rehabilitation Hospital, Hyogo, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Taguchi
authors.affiliation: Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Maruo
authors.affiliation: Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kageyama
authors.affiliation: Takarazuka Rehabilitation Hospital, Hyogo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kinoshita
authors.affiliation: Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Goto
authors.affiliation: Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Shimokawa
authors.affiliation: Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Koyama
authors.affiliation: Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: neurosaitoh@mbk.nifty.com.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Saitoh
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D018737:Hand Strength; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009044:Motor Cortex / Q000503:physiopathology*; D010291:Paresis / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D020127:Recovery of Function; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D065908:Transcranial Direct Current Stimulation / Q000009:adverse effects; D016896:Treatment Outcome; D034941:Upper Extremity / Q000294:innervation*
keywords: Repetitive transcranial magnetic stimulation; motor cortex stimulation; randomized controlled trial; rehabilitation; stroke recovery; subacute stroke