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Transcranial magnetic stimulation in mild to severe hemiparesis early after stroke: a proof of principle and novel approach to improve motor function

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Abstract

Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the unaffected hemisphere can enhance function of the paretic hand in patients with mild motor impairment. Effects of low-frequency rTMS to the contralesional motor cortex at an early stage of mild to severe hemiparesis after stroke are unknown. In this pilot, randomized, double-blind clinical trial we compared the effects of low-frequency rTMS or sham rTMS as add-on therapies to outpatient customary rehabilitation, in 30 patients within 5–45 days after ischemic stroke, and mild to severe hand paresis. The primary feasibility outcome was compliance with the interventions. The primary safety outcome was the proportion of intervention-related adverse events. Performance of the paretic hand in the Jebsen–Taylor test and pinch strength were secondary outcomes. Outcomes were assessed at baseline, after ten sessions of treatment administered over 2 weeks and at 1 month after end of treatment. Baseline clinical features were comparable across groups. For the primary feasibility outcome, compliance with treatment was 100% in the active group and 94% in the sham group. There were no serious intervention-related adverse events. There were significant improvements in performance in the Jebsen–Taylor test (mean, 12.3% 1 month after treatment) and pinch force (mean, 0.5 Newtons) in the active group, but not in the sham group. Low-frequency rTMS to the contralesional motor cortex early after stroke is feasible, safe and potentially effective to improve function of the paretic hand, in patients with mild to severe hemiparesis. These promising results will be valuable to design larger randomized clinical trials.

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Acknowledgments

This work was funded by grant 2006/55504-0 from São Paulo State’s Foundation for Research Support (FAPESP), a Brazilian governmental agency. The authors have no financial relationships with FAPESP. Scholarships from FAPESP were funded to Erina Nagaya (2009/51641-0 and 2010/12696-1) and Sarah dos Anjos (2010/15660-8). FAPESP had no roles in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. We thank David Luckenbaugh for helpful discussions about statistical analysis of the data.

Conflicts of interest

The authors have no conflicts of interest.

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Authors and Affiliations

  1. Division of Clinical Neurology, Hospital das Clínicas, University of São Paulo, Av. Dr. Enéas C. Aguiar 255/5084, São Paulo, 05403010, Brazil

    Adriana B. Conforto, Sarah M. Anjos, Eduardo A. Mello, Erina M. Nagaya, Waldyr Santos Jr., Karina N. Ferreiro, Eduardo S. Melo, Felipe I. Reis & Milberto Scaff

  2. The Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil

    Adriana B. Conforto

  3. Stroke Outcomes Research Unit, St. Michael’s Hospital, University of Toronto, Toronto, Canada

    Gustavo Saposnik

  4. The Human Cortical Physiology and Stroke Rehabilitation Section, National Institutes of Neurological Disorders and Stroke, Bethesda, USA

    Leonardo G. Cohen

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  1. Adriana B. Conforto
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  2. Sarah M. Anjos
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  3. Gustavo Saposnik
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  4. Eduardo A. Mello
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Correspondence to Adriana B. Conforto.

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Conforto, A.B., Anjos, S.M., Saposnik, G. et al. Transcranial magnetic stimulation in mild to severe hemiparesis early after stroke: a proof of principle and novel approach to improve motor function. J Neurol 259, 1399–1405 (2012). https://doi.org/10.1007/s00415-011-6364-7

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  • DOI: https://doi.org/10.1007/s00415-011-6364-7

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