Dual-mode noninvasive brain stimulation over the bilateral primary motor cortices in stroke patients

Article type: Research Article

Authors: Cho, Jae Yong^a | Lee, Ahee^b | Kim, Min Su^c | Park, Eunhee^a | Chang, Won Hyuk^a | Shin, Yong-Il^d | Kim, Yun-Hee^{a; b; *}

Affiliations: [a] Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea | [b] Department of Health Science and Technology, Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea | [c] Department of Rehabilitation Medicine, Wonkwang University, College of Medicine, Iksan, Republic of Korea | [d] Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea

Correspondence: [*] Corresponding author: Yun-Hee Kim, M.D., Ph.D., Professor, Department of Physical and Rehabilitation Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu. Seoul, 06351, Republic of Korea. Tel.: +82 2 3410 2824, 2818; Fax: +82 2 3410 0388; E-mails: yunkim@skku.edu, yun1225.kim@samsung.com.

Abstract: Background: Noninvasive brain stimulation (NBS) using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) has recently been adopted for modulating motor function in stroke patients. Objective: We investigated the effect of simultaneous dual-mode stimulation using rTMS and tDCS over the bilateral primary motor cortices (M1) to assess its efficacy as compared to single stimulation using rTMS for the recovery of motor function in subacute stroke patients. Methods: Thirty subacute stroke patients were recruited in this study. In the dual-mode stimulation group, 10 Hz rTMS (90% of resting motor threshold, 1,000 pulses) was applied over the ipsilesional M1 for 20 minutes with the simultaneous application of cathodal tDCS (2 mA) on the contralesional M1. The single stimulation group underwent 10 Hz rTMS without tDCS. Ten daily sessions were conducted for two consecutive weeks. The total Fugl-Meyer (FMA-T), upper limb (FMA-UL), and lower limb (FMA-LL) scores were measured before, after, and two months later. Results: The FMA-T and FMA- UL were significantly improved over time in both the dual and single stimulation group (p < 0.05). However, there were significant group and time interaction effects in both the FMA-T and FMA-UL (p < 0.05). Post-hoc analysis showed that the mean changes in the FMA-T and FMA-UL were significantly better in the dual-mode stimulation group. Conclusion: Dual-mode NBS with the simultaneous application of 10 Hz rTMS and cathodal tDCS over the bilateral M1s was safe and superior to 10 Hz rTMS alone for improving motor function in subacute stroke patients.

Keywords: Noninvasive brain stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, stroke, motor function

DOI: 10.3233/RNN-160669

Journal: Restorative Neurology and Neuroscience, vol. 35, no. 1, pp. 105-114, 2017