Affiliations: Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan | Department of Emergency, Mackay Memorial Hospital, Taipei, Taiwan | School of Medicine, National Yang-Ming University, Taipei, Taiwan | Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan | Department of Medicine, Mackay Medical College, Taipei, Taiwan
Note: [] Corresponding author: Dr. Po-Yi Tsai, Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan. No. 201, Shih- Pai Rd, Sec. 2, Taipei 11217, Taiwan. Tel.: +886 228757293; Fax: +886 228757359; E-mail: pytsai@vghtpe.gov.tw
Abstract: Purpose: The premotor cortex plays a major role in motor planning and control, exhibiting hierarchical importance comparable to that of the primary motor cortex (M1). In this study, we compared the effects of cPMd modulation, which was achieved using inhibitory repetitive transcranial magnetic stimulation (rTMS), with those of contralesional M1 (cM1) modulation, to elucidate the roles of both regions on longitudinal motor recovery following a stroke. Methods: Forty-four patients who had sustained hemiplegia for 3 to 12 months were randomly allocated to a cPMd group, cM1 group, or sham group and received 10 sessions of 1-Hz rTMS. The Medical Research Council (MRC) Scale, Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), and a cortical excitability test were administered pre- and post- rTMS intervention. Results: cPMd modulation yielded significant improvements in MRC, FMA, and WMFT scores compared with sham stimulation and a significant effect on cortical excitability suppression equivalent to that of cM1 modulation, but engendered effects on motor improvement inferior to those of cM1 modulation. Conclusions: In patients with chronic stroke, the cPMd can fulfill a role similar to that of the cM1 in interhemispheric imbalance, which can be ameliorated by applying inhibitory rTMS to achieve substantial motor restoration.
Keywords: Repetitive transcranial magnetic stimulation (rTMS), stroke, dorsal premotor cortex (PMd), primary motor cortex (M1), motor recovery, neuromodulation
