Affiliations: [a] BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research (InFo), Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| [b]
Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany
| [c]
Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| [d]
Section of Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| [e]
Department of Neurology, Hannover Medical School, Hannover, Germany
| [f] BDH-Clinic Elzach, Elzach, Germany
Correspondence:
[*]
Address for correspondence: Melanie Boltzmann, BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research (InFo), Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany. E-mail: m.boltzmann@bdh-klinik-hessisch-oldendorf.de.
Abstract: BACKGROUND:Upper limb dysfunction is a frequent complication after stroke impairing outcome. Inhibitory repetitive transcranial magnetic stimulation (rTMS) applied over the contralesional hemisphere is supposed to enhance the positive effects of conventional rehabilitative treatment. OBJECTIVE:This double-blind randomized placebo-controlled trial investigated whether inhibitory rTMS as add-on to standard therapy improves upper limb spasticity. METHODS:Twenty-eight patients (aged 44 to 80 years) with unilateral stroke in the middle cerebral artery territory were analyzed. Participants were randomly assigned to inhibitory, low-frequency (LF-) rTMS (n = 14) or sham-rTMS (n = 14). The primary outcome measure was the spasticity grade, which was assessed with the Modified Ashworth Scale (MAS). In addition, the Fugl-Meyer-Assessment (FMA) for the upper extremity (UE) and a resting-state fMRI were performed to measure motor functions and the sensorimotor network, respectively. RESULTS:The MAS score was reduced in the LF-rTMS group only, whereas the FMA score improved in both groups over time. Regarding the fMRI data, both groups activated typical regions of the sensorimotor network. In the LF-rTMS group, however, connectivity to the left angular gyrus increased after treatment. CONCLUSION:Changes in functional connectivity in patients receiving inhibitory rTMS over the contralesional motor cortex suggest that processes of neuronal plasticity are stimulated.
