Effects of coupling inhibitory and facilitatory repetitive transcranial magnetic stimulation on motor recovery in patients following acute cerebral infarction

Article type: Research Article

Authors: Chen, Qingmei^{a; b; 1} | Shen, Dan^{a; 1} | Sun, Haiwei^{d; 1} | Ke, Jun^c | Wang, Hongxia^a | Pan, Shenjie^a | Liu, Haoyu^b | Wang, Dapeng^{a; 2} | Su, Min^{b; *; 2} | Fang, Qi^{a; *; 2}

Affiliations: [a] Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China | [b] Department of Physical Medicine & Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China | [c] Department of Medical Imaging, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China | [d] Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China

Correspondence: [*] Address for correspondence: Qi Fang, MD, PhD, Department of Neurology, The First Affiliated Hospital of Soochow University, Pinghai Road 899, Suzhou, 215000, Jiangsu Province, China. Tel.: +86 13606213892; E-mail: fangqi@suda.edu.cn and Min Su, MD, PhD. Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University No. 68 Wuque Bridge Road, Gusu District Suzhou City, Jiangsu Province, China, Zip: 215006, Tel.: +86 17712661015; E-mail: sumin@139.com.

Note: [1] Qingmei Chen, Dan Shen and Haiwei Sun contributed equally to the study and are co-first authors of this article.

Note: [2] Dapeng Wang, Min Su and Qi Fang are co-corresponding authors.

Abstract: BACKGROUND:The treatment for patients suffering from motor dysfunction following stroke using continuous repetitive transcranial magnetic stimulation (rTMS) has the potential to be beneficial for recovery. However, the impact of explicit results on the coupling of various rTMS protocols on motor treatment in patients following acute cerebral infarction remain unexplored. OBJECTIVE:The current study aims to design a sham-controlled randomized report to explore the capability of consecutive suppressive-facilitatory rTMS method to increase the motor results following acute stroke. METHODS:A hundred ischemic stroke patients suffering from motor disorder were randomly assigned to obtain 4 week sessions of (1)10 Hz over the ipsilesional primary motor cortex (M1) and next 1 Hz over the contralesional M1; (2) contralesional sham stimulation and next ipsilesional real 10 Hz; (3) contralesional real 1 Hz rTMS and next ipsilesional sham stimulation; or (4) bilateral sham-control procedures. At 24 hours before and after the intervention, we obtained cortical excitability data from study subjects. At baseline, after treatment and 3 months follow up, we additionally evaluated patients with the clinical assessments. RESULTS:At post-intervention, group A showed greater motor improvements in FMA, FMA-UL, NIHSS, ADL and mRS values than group B, group C and group D, that were continued for at least 3 months after the completion of the treatment time. Specifically, it is shown in the cortical excitability study that the motor-evoked potential (MEP) amplitude and resting motor threshold (rMT) more significantly improved in group A than other groups. The improvement in motor function and change in motor cortex excitability exhibit a significant correlation in the affected hemisphere. The combined 1 Hz and 10 Hz stimulation treatment showed a synergistic effect. CONCLUSIONS:Facilitatory rTMS and coupling inhibitory produced extra satisfactory results in facilitating the motor’s recovery in the subacute and acute phase following stroke compared to that acquired from alone single-course modulation.

Keywords: Facilitatory repetitive magnetic stimulation, inhibitory repetitive transcranial magnetic stimulation, motor function, stroke, treatment

DOI: 10.3233/NRE-201606

Journal: NeuroRehabilitation, vol. 48, no. 1, pp. 83-96, 2021