title: Additive effects of sequential excitatory and inhibitory theta burst stimulation in improving cortical excitability following ischaemic stroke.
abstract: OBJECTIVE
  To study the effects of sequential excitatory and inhibitory theta burst stimulation (TBS) on cortical excitability in patients with subacute ischaemic stroke.
  
  
  METHODS
  Fifteen patients with first-ever middle cerebral artery ischaemic stroke within last three months were subjected to intermittent TBS over the hand area (M1) of the stroke hemisphere (iTBSSH) followed by continuous TBS over the intact hemisphere M1 (cTBSIH). The study measured motor evoked potential (MEP) amplitude, resting motor threshold (RMT) and contralateral cortical silent period (cCSP) at baseline and after 7 minutes of each TBS session.
  
  
  RESULTS
  The mean age of the patients was 62.4 ± 8.0 years. The absolute changes in baseline motor physiological parameters were significantly greater after cTBSIHthan after iTBSSH(p = 0.001). Following iTBSSH, there was a significant decrease in mean RMT (7.4%; p < 0.001). Following cTBSIH, there was further 18.3% increase in mean MEP amplitude and decrease in mean RMT (4.7%; p < 0.001) and cCSP (5.6%; p < 0.001) of the stroke hemisphere. Similar changes of smaller magnitude were noted in 12 age-matched controls.
  
  
  CONCLUSIONS
  The results indicate that combining iTBSSHand cTBSIHcan have additive effect in increasing cortical excitability in subacute ischaemic patients with stroke.
authors.affiliation: a Department of Physical Therapy, Faculty of Applied Medical Science , King Abdulaziz University , Jeddah , Saudi Arabia.
authors.forename: Fayaz Rahman
authors.initials: FR
authors.lastname: Khan
mesh_terms: D000368:Aged; D020520:Brain Infarction / Q000209:etiology; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D007839:Functional Laterality; D006225:Hand / Q000294:innervation; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D013826:Theta Rhythm; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: Transcranial magnetic stimulation; rehabilitation; stroke; theta burst stimulation