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Abdelkader AA, Afifi LM, Maher EA, Atteya AA, El Salmawy DA. Comparison of Bilateral Versus Unilateral 5 Hz or 1 Hz Repetitive Transcranial Magnetic Stimulation in Subacute Stroke: Assessment of Motor Function in a Randomized Controlled Study. J Clin Neurophysiol 2024; 41:478-483. [PMID: 38935659 DOI: 10.1097/wnp.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
PURPOSE Repetitive transcranial magnetic stimulation (rTMS) can enhance brain plasticity after stroke. At low frequencies, rTMS has an inhibitory effect, whereas at high frequencies, it has an excitatory effect. Combining both frequencies in bilateral stimulation is a new rTMS protocol under investigation, especially in the subacute stage. METHODS Fifty-five patients with subacute stroke were divided into four groups according to the rTMS protocol delivered: bilateral, inhibitory, excitatory, and control groups. All groups received concomitant task-oriented physiotherapy. Pretreatment to posttreatment assessment was performed twice, immediately after sessions and 1 month later. Volitional motor control was evaluated by Fugl-Meyer and Wolf motor function tests, and for spasticity, the Ashworth scale was used. RESULTS All groups showed significant improvement. Bilateral, inhibitory, and excitatory groups showed same efficacy, but the bilateral protocol was superior in spasticity. No correlations were found between improvement and stroke duration and site except for spasticity. CONCLUSIONS Bilateral rTMS shows a comparable effect to inhibitory and excitatory rTMS in improving motor disability in subacute stroke. However, it is superior for spasticity.
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Affiliation(s)
- Ann A Abdelkader
- Clinical Neurophysiology Unit, Department of Neurology, Kasr Alaini Hospital, Cairo University, Cairo, Egypt; and
| | - Lamia M Afifi
- Clinical Neurophysiology Unit, Department of Neurology, Kasr Alaini Hospital, Cairo University, Cairo, Egypt; and
| | - Eman A Maher
- Clinical Neurophysiology Unit, Department of Neurology, Kasr Alaini Hospital, Cairo University, Cairo, Egypt; and
| | | | - Dina A El Salmawy
- Clinical Neurophysiology Unit, Department of Neurology, Kasr Alaini Hospital, Cairo University, Cairo, Egypt; and
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Marín-Medina DS, Arenas-Vargas PA, Arias-Botero JC, Gómez-Vásquez M, Jaramillo-López MF, Gaspar-Toro JM. New approaches to recovery after stroke. Neurol Sci 2024; 45:55-63. [PMID: 37697027 PMCID: PMC10761524 DOI: 10.1007/s10072-023-07012-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/07/2023] [Indexed: 09/13/2023]
Abstract
After a stroke, several mechanisms of neural plasticity can be activated, which may lead to significant recovery. Rehabilitation therapies aim to restore surviving tissue over time and reorganize neural connections. With more patients surviving stroke with varying degrees of neurological impairment, new technologies have emerged as a promising option for better functional outcomes. This review explores restorative therapies based on brain-computer interfaces, robot-assisted and virtual reality, brain stimulation, and cell therapies. Brain-computer interfaces allow for the translation of brain signals into motor patterns. Robot-assisted and virtual reality therapies provide interactive interfaces that simulate real-life situations and physical support to compensate for lost motor function. Brain stimulation can modify the electrical activity of neurons in the affected cortex. Cell therapy may promote regeneration in damaged brain tissue. Taken together, these new approaches could substantially benefit specific deficits such as arm-motor control and cognitive impairment after stroke, and even the chronic phase of recovery, where traditional rehabilitation methods may be limited, and the window for repair is narrow.
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Affiliation(s)
- Daniel S Marín-Medina
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Paula A Arenas-Vargas
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Juan C Arias-Botero
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Manuela Gómez-Vásquez
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Manuel F Jaramillo-López
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jorge M Gaspar-Toro
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
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Safdar A, Smith MC, Byblow WD, Stinear CM. Applications of Repetitive Transcranial Magnetic Stimulation to Improve Upper Limb Motor Performance After Stroke: A Systematic Review. Neurorehabil Neural Repair 2023; 37:837-849. [PMID: 37947106 PMCID: PMC10685705 DOI: 10.1177/15459683231209722] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Noninvasive brain stimulation (NIBS) is a promising technique for improving upper limb motor performance post-stroke. Its application has been guided by the interhemispheric competition model and typically involves suppression of contralesional motor cortex. However, the bimodal balance recovery model prompts a more tailored application of NIBS based on ipsilesional corticomotor function. OBJECTIVE To review and assess the application of repetitive transcranial magnetic stimulation (rTMS) protocols that aimed to improve upper limb motor performance after stroke. METHODS A PubMed search was conducted for studies published between 1st January 2005 and 1st November 2022 using rTMS to improve upper limb motor performance of human adults after stroke. Studies were grouped according to whether facilitatory or suppressive rTMS was applied to the contralesional hemisphere. RESULTS Of the 492 studies identified, 70 were included in this review. Only 2 studies did not conform to the interhemispheric competition model, and facilitated the contralesional hemisphere. Only 21 out of 70 (30%) studies reported motor evoked potential (MEP) status as a biomarker of ipsilesional corticomotor function. Around half of the studies (37/70, 53%) checked whether rTMS had the expected effect by measuring corticomotor excitability (CME) after application. CONCLUSION The interhemispheric competition model dominates the application of rTMS post-stroke. The majority of recent and current studies do not consider bimodal balance recovery model for the application of rTMS. Evaluating CME after the application rTMS could confirm that the intervention had the intended neurophysiological effect. Future studies could select patients and apply rTMS protocols based on ipsilesional MEP status.
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Affiliation(s)
- Afifa Safdar
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Marie-Claire Smith
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Winston D. Byblow
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Cathy M. Stinear
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Chen R, Zhang Y, Wang X, Zhao Y, Fan S, Xue Y, Zhao J, Liu Y, Wang P. Treatment effects of low-frequency repetitive transcranial magnetic stimulation combined with motor relearning procedure on spasticity and limb motor function in stroke patients. Front Neurol 2023; 14:1213624. [PMID: 37638202 PMCID: PMC10456998 DOI: 10.3389/fneur.2023.1213624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/20/2023] [Indexed: 08/29/2023] Open
Abstract
Objective Limb paralysis, which is a sequela of stroke, limits patients' activities of daily living and lowers their quality of life. The purpose of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with a motor relearning procedure (MRP) on motor function and limb spasticity in stroke patients. Methods Stroke patients were randomly divided into a combined treatment group (rTMS + MRP) and a control group (MRP) (n = 30 per group). The control group was given MRP in addition to conventional rehabilitation, and the combined treatment group was given 1 Hz rTMS combined with MRP. The treatment efficacy was assessed by the modified Ashworth scale (MAS), Fugl-Meyer motor function scale, and motor evoked potential (MEP) testing. Results After 4 weeks of treatment, the Brunnstrom score, Fugl-Meyer lower extremity motor function, and Fugl-Meyer balance function were significantly higher in the combination treatment group compared to the control group, while the MAS score was lower in the combination treatment group compared to the control group. The MEP extraction rate was higher in the combined treatment group compared to the control group, while the threshold and central motor conduction time (CMCT) were lower in the combined treatment group compared to the control group. Conclusion Low-frequency rTMS combined with MRP had better efficacy on spasticity and motor function in stroke patients with hemiparesis than MRP alone.
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Affiliation(s)
- Ruijun Chen
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Zhang
- Department of Traditional Chinese Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Traditional Chinese Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaocheng Wang
- Department of Medical Record and Statistics, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Yunfei Zhao
- College of Sports Rehabilitation, Shanxi Medical University, Jinzhong, China
| | - Shasha Fan
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanping Xue
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Zhao
- Department of Medical Record Management, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Medical Record Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinlian Liu
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pingzhi Wang
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Recovery of Patients With Upper Limb Paralysis Due to Stroke Who Underwent Intervention Using Low-Frequency Repetitive Transcranial Magnetic Stimulation Combined With Occupational Therapy: A Retrospective Cohort Study. Neuromodulation 2023:S1094-7159(23)00104-6. [PMID: 36932028 DOI: 10.1016/j.neurom.2023.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES The combination of repetitive transcranial magnetic stimulation (rTMS) and motor practice is based on the theory of neuromodulation and use-dependent plasticity. Predictive planning of occupational therapy (OT) is important for patients with rTMS conditioning. Recovery characteristics based on the severity of pretreatment upper extremity paralysis can guide the patient's practice plan for using the paretic hand. Therefore, we evaluated the recovery of patients with upper limb paralysis due to stroke who underwent a novel intervention of rTMS combined with OT (NEURO) according to the severity of upper limb paralysis based on the scores of the Fugl-Meyer assessment for upper extremity (FMA-UE) with recovery in proximal upper extremity, wrist, hand, and coordination. MATERIALS AND METHODS In this multicenter retrospective cohort study, the recovery of 1397 patients with upper limb paralysis was analyzed by severity at six hospitals that were accredited by the Japanese Stimulation Therapy Society for treatment. The delta values of the FMA-UE scores before and after NEURO were compared among the groups with severe, moderate, and mild paralysis using the generalized linear model. RESULTS NEURO significantly improved the FMA-UE total score according to the severity of paralysis (severe = 5.3, moderate = 6.0, and mild = 2.9). However, when the FMA-UE subscores were analyzed separately, the results indicated specific improvements in shoulder/elbow, wrist, fingers, and coordination movements, depending on the severity. CONCLUSIONS This study had enough patients who were divided according to severity and stratified by lesion location and handedness parameters. Our results suggest that independently of these factors, the extent of recovery of upper limb motor parts after NEURO varies according to the severity of paralysis.
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Chino T, Kinoshita S, Abo M. Repetitive Transcranial Magnetic Stimulation and Rehabilitation Therapy for Upper Limb Hemiparesis in Stroke Patients: A Narrative Review. Prog Rehabil Med 2023; 8:20230005. [PMID: 36866154 PMCID: PMC9970844 DOI: 10.2490/prm.20230005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/31/2023] [Indexed: 03/04/2023] Open
Abstract
Recent technological advances in non-invasive brain stimulation (NIBS) have led to the development of therapies for post-stroke upper extremity paralysis. Repetitive transcranial magnetic stimulation (rTMS), a NIBS technique, controls regional activity by non-invasively stimulating selected areas of the cerebral cortex. The therapeutic principle by which rTMS is thought to work is the correction of interhemispheric inhibition imbalances. The guidelines for rTMS for post-stroke upper limb paralysis have graded it as a highly effective treatment, and, based on functional brain imaging and neurophysiological testing, it has been shown to result in progress toward normalization. Our research group has published many reports showing improvement in upper limb function after administration of the NovEl Intervention Using Repetitive TMS and intensive one-to-one therapy (NEURO), demonstrating its safety and efficacy. Based on the findings to date, rTMS should be considered as a treatment strategy based on a functional assessment of the severity of upper extremity paralysis (Fugl-Meyer Assessment), and NEURO should be combined with pharmacotherapy, botulinum treatment, and extracorporeal shockwave therapy to maximize therapeutic effects. In the future, it will be important to establish tailormade treatments in which stimulation frequency and sites are adjusted according to the pathological conditions of interhemispheric imbalance, as revealed by functional brain imaging.
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Affiliation(s)
- Toshifumi Chino
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kinoshita
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Anti-spastic effect of contralesional dorsal premotor cortex stimulation in stroke patients with moderate-to-severe spastic paresis: a randomized, controlled pilot trial. Acta Neurol Belg 2023:10.1007/s13760-023-02212-2. [PMID: 36809647 DOI: 10.1007/s13760-023-02212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE This study aimed at investigating the effect of a single-session repetitive transcranial magnetic stimulation (rTMS) of the contralesional dorsal premotor cortex on poststroke upper-limb spasticity. MATERIAL AND METHODS The study consisted of the following three independent parallel arms: inhibitory rTMS (n = 12), excitatory rTMS (n = 12), and sham stimulation (n = 13). The primary and secondary outcome measures were the Modified Ashworth Scale (MAS) and F/M amplitude ratio, respectively. A clinically meaningful difference was defined as a reduction in at least one MAS score. RESULTS There was a statistically significant change in MAS score within only the excitatory rTMS group over time [median (interquartile range) of - 1.0 (- 1.0 to - 0.5), p = 0.004]. However, groups were comparable in terms of median changes in MAS scores (p > 0.05). The proportions of patients achieving at least one MAS score reduction (9/12 in the excitatory rTMS group, 5/12 in the inhibitory rTMS group, and 5/13 in the control group) were also comparable (p = 0.135). For the F/M amplitude ratio, main time effect, main intervention effect, and time-intervention interaction effect were not statistically significant (p > 0.05). CONCLUSIONS Modulation of the contralesional dorsal premotor cortex with a single-session of excitatory or inhibitory rTMS does not appear to have an immediate anti-spastic effect beyond sham/placebo. The implication of this small study remains unclear and further studies into excitatory rTMS for the treatment of moderate-to-severe spastic paresis in poststroke patients should be undertaken. CLINICAL TRIAL REGISTRATION NO NCT04063995 (clinicaltrials.gov).
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Yamada N, Kashiwabara K, Takekawa T, Hama M, Niimi M, Hara T, Furumizo S, Tsuboi M. Comparison of the effect and treatment sequence between a 2-week parallel repetitive transcranial magnetic stimulation and rehabilitation and a 2-week rehabilitation-only intervention during a 4-week hospitalization for upper limb paralysis after stroke: An open-label, crossover observational study. J Cent Nerv Syst Dis 2022; 14:11795735211072731. [PMID: 35082548 PMCID: PMC8785323 DOI: 10.1177/11795735211072731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/12/2021] [Accepted: 12/14/2021] [Indexed: 11/15/2022] Open
Abstract
Background NEURO® is a 2-week program that combines low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) to treat patients with chronic hemiparesis following stroke. The degree to which each element contributes to the improvement of upper limb function remains unclear. It has been suggested that low-frequency rTMS applied to a healthy cerebrum activates neural activity in the contralateral hemispheric area surrounding the lesion. Intensive OT performed in parallel to rTMS promotes the functional remodeling of the cerebrum to help with rehabilitation. OBJECTIVES However, this has not been demonstrated using NEURO®. Therefore, we aimed to compare the effects of the NEURO® and OT-only protocols in patients with hemiparesis following stroke. Methods Thirty-seven patients with upper limb paralysis following stroke were recruited and hospitalized for treatments and randomly divided into two groups. Group A consisted of 16 patients who underwent NEURO® for the first 2 weeks, and Group B consisted of 21 patients who underwent OT-only for the first 2 weeks. After 2 weeks of hospitalization, the treatments of Groups A and B were reversed for the subsequent 2 weeks of treatment. Improvement in upper limb motor function in Groups A and B at 2 and 4 weeks after the start of treatment was evaluated using the Fugl-Meyer Motor Assessment (FMA) and the Wolf Motor Function Test (WMFT). Results Group A, who underwent NEURO® first during their initial 2-week hospitalization, showed significantly greater improvement than that in Group B, who underwent OT-only first ( P = .041 for FMA and P < .01 for WMFT). At 4 weeks following the reversal of treatments, Group A who underwent NEURO® and then OT-only showed significantly greater improvement than that in Group B, who underwent OT-only followed by NEURO® ( P = .011 for FMA and P = .001 for WMFT). Conclusion Our findings indicate that rTMS facilitates neuromodulation when combined with OT, which leads to more effective rehabilitation than with OT alone (Trial registration: JMACCT ( http://www.jmacct.med.or.jp/ ); trial ID JMA-IIA00215).
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Affiliation(s)
- Naoki Yamada
- Department of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan
| | | | - Toru Takekawa
- Department of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Midori Hama
- Department of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Masachika Niimi
- Department of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Takatoshi Hara
- Department of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Furumizo
- Department of Rehabilitation Medicine, Tokyo General Hospital, Tokyo, Japan
| | - Marika Tsuboi
- Department of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Tokyo General Hospital, Tokyo, Japan
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Tatsuno H, Hamaguchi T, Sasanuma J, Kakita K, Okamoto T, Shimizu M, Nakaya N, Abo M. Does a combination treatment of repetitive transcranial magnetic stimulation and occupational therapy improve upper limb muscle paralysis equally in patients with chronic stroke caused by cerebral hemorrhage and infarction?: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e26339. [PMID: 34128880 PMCID: PMC8213260 DOI: 10.1097/md.0000000000026339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/28/2021] [Indexed: 01/04/2023] Open
Abstract
The clinical presentation of stroke is usually more severe in patients with intracerebral hemorrhage (ICH) than in those with cerebral infarction (CI); recovery of stroke-related muscle paralysis is influenced and limited by the type of stroke. To date, many patients have been treated by neurorehabilitation; however, the changes in the recovery of motor paralysis depending on the type of stroke, ICH or CI, have not been established. This study aimed to determine this difference in improvement of upper extremity paralysis using 2-week in-hospital NovEl intervention Using Repetitive transcranial magnetic stimulation combined with Occupational therapy (NEURO).We scrutinized the medical records of all patients with poststroke (ICH or CI) upper extremity muscle paralysis using Fugl-Meyer assessments (FMAs) who had been admitted to 6 hospitals between March 2010 and December 2018 for rehabilitation treatment. This was a multiinstitutional, open-label, retrospective cohort study without control patients. We evaluated the effects of NEURO on patients with CI and ICH by dividing them into 2 groups according to the type of stroke, after adjustment for age, sex, dominant hand, affected hand side, time since stroke, and prediction of recovery capacity in the upper extremity.The study included 1716 (CI [n = 876] and ICH [n = 840]) patients who had undergone at least 2 FMAs and had experienced stroke at least 6 months before. The type of stroke had no effect on the outcomes (changes in the FMA-upper extremity score, F[4,14.0] = 2.05, P = .09, partial η2 = 0.01). Patients from all 5 groups equally benefited from the treatment (improvement in FMA scores) according to the sensitivity analysis-stratified analysis (F = 0.08 to 1.94, P > .16, partial η2 < 0.001).We conclude that NEURO can be recommended for chronic stroke patients irrespective of the type of stroke.
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Affiliation(s)
- Hisashi Tatsuno
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo
| | - Toyohiro Hamaguchi
- Department of Rehabilitation, Graduate School of Health Sciences, Saitama Prefectural University, Saitama
| | | | | | | | | | - Naoki Nakaya
- Department of Rehabilitation, Graduate School of Health Sciences, Saitama Prefectural University, Saitama
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo
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Hamaguchi T, Yamada N, Hada T, Abo M. Prediction of Motor Recovery in the Upper Extremity for Repetitive Transcranial Magnetic Stimulation and Occupational Therapy Goal Setting in Patients With Chronic Stroke: A Retrospective Analysis of Prospectively Collected Data. Front Neurol 2020; 11:581186. [PMID: 33193036 PMCID: PMC7606467 DOI: 10.3389/fneur.2020.581186] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/03/2020] [Indexed: 01/03/2023] Open
Abstract
Recovery from motor paralysis is facilitated by affected patients' recognition of the need for and practice of their own exercise goals. Neurorehabilitation has been proposed and used for the treatment of motor paralysis in stroke, and its effect has been verified. If an expected score for the neurorehabilitation effect can be calculated using the Fugl-Meyer Motor Assessment (FMA), a global assessment index, before neurorehabilitation, such a score will be useful for optimizing the treatment application criteria and for setting a goal to enhance the treatment effect. Therefore, this study verified whether the responsiveness to a treatment method, the NovEl intervention using repetitive transcranial magnetic stimulation and occupational therapy (NEURO), in patients with post-stroke upper extremity (UE) motor paralysis could be predicted by the pretreatment FMA score. No control group was established in this study for NEURO treatment. To analyze the recovery of the motor function in the UE, delta-FMA was calculated from the pre- and post-FMA scores obtained during NEURO treatment. The probability of three levels of treatment responsiveness was evaluated in association with delta-FMA score (<5, 5 ≤ delta-FMA <10, and ≥10 as non-responders; responders; and hyper-responders, respectively) according to the reported minimal clinically important difference (MCID). The association of the initial FMA scores with post-FMA scores, from the status of the treatment responsiveness, was determined by multinomial logistic regression analysis. Finally, 1,254 patients with stroke, stratified by FMA scores were analyzed. About 45% of the patients who had FMA scores ranging from 30 to 40 before treatment showed improvement over the MCID by NEURO treatment (odds ratio = 0.93, 95% CI = 0.92–0.95). Furthermore, more than 25% of the patients with more severe initial values, ranging from 26 to 30, improved beyond the MCID calculated in the acute phase (odds ratio = 0.87, 95% CI = 0.85–0.89). These results suggest that the evaluated motor function score of the UE before NEURO treatment can be used to estimate the possibility of a patient recovering beyond MCID in the chronic phase. This study provided clinical data to estimate the effect of NEURO treatment by the pretreatment FMA-UE score.
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Affiliation(s)
- Toyohiro Hamaguchi
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Rehabilitation, Graduate School of Health Sciences, Saitama Prefectural University, Koshigaya, Japan
| | - Naoki Yamada
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takuya Hada
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Corticomotor excitability after two different repetitive transcranial magnetic stimulation protocols in haemorrhagic stroke patients. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ueda R, Yamada N, Abo M, Ruwan PW, Senoo A. MRI evaluation of motor function recovery by rTMS and intensive occupational therapy and changes in the activity of motor cortex. Int J Neurosci 2019; 130:309-317. [DOI: 10.1080/00207454.2019.1680553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ryo Ueda
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Naoki Yamada
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Pradeepa Wanniarachchi Ruwan
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Atsushi Senoo
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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Luo Y, Yang J, Wang H, Gan Z, Ran D. Cellular Mechanism Underlying rTMS Treatment for the Neural Plasticity of Nervous System in Drosophila Brain. Int J Mol Sci 2019; 20:ijms20184625. [PMID: 31540425 PMCID: PMC6770261 DOI: 10.3390/ijms20184625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/03/2019] [Accepted: 09/13/2019] [Indexed: 01/20/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is used as a research tool and clinical treatment for the non-clinical and clinical populations, to modulate brain plasticity. In the case of neurologic and psychiatric disease, there is significant evidence to suggest that rTMS plays an important role in the functional recovery after neurological dysfunction. However, the causal role for rTMS in the recovery of nervous dysfunction remains unclear. The purpose of the present study is to detect the regulation of rTMS on the excitatory neuronal transmission and specify the mode of action of rTMS on the neural plasticity using Drosophila whole brain. Therefore, we identified the effects of rTMS on the neural plasticity of central neural system (CNS) by detecting the electrophysiology properties of projection neurons (PNs) from adult Drosophila brain after rTMS. Using patch clamp recordings, we recorded the mini excitatory postsynaptic current (mEPSC) of PNs after rTMS at varying frequencies (1 Hz and 100 Hz) and intensities (1%, 10%, 50%, and 100%). Then, the chronic electrophysiology recordings, including mEPSC, spontaneous action potential (sAP), and calcium channel currents from PNs after rTMS at low frequency (1 Hz), with low intensity (1%) were detected and the properties of the recordings were analyzed. Finally, the frequency and decay time of mEPSC, the resting potential and frequency of sAP, and the current density and rise time of calcium channel currents were significantly changed by rTMS. Our work reveals that rTMS can be used as a tool to regulate the presynaptic function of neural circuit, by modulating the calcium channel in a frequency-, intensity- and time-dependent manner.
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Affiliation(s)
- Ying Luo
- Department of Pharmacology, Chongqing Medical University, Chongqing 400016, China.
- The Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, Chongqing 400016, China.
| | - Junqing Yang
- Department of Pharmacology, Chongqing Medical University, Chongqing 400016, China.
- The Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, Chongqing 400016, China.
| | - Hong Wang
- Department of Pharmacology, Chongqing Medical University, Chongqing 400016, China.
- The Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, Chongqing 400016, China.
| | - Zongjie Gan
- Department of Pharmacology, Chongqing Medical University, Chongqing 400016, China.
- Chongqing Research Center for Pharmaceutical Engineering, Chongqing Medical University, Chongqing 400016, China.
| | - Donzhi Ran
- Department of Pharmacology, Chongqing Medical University, Chongqing 400016, China.
- The Key Laboratory of Biochemistry and Molecular Pharmacology, Chongqing Medical University, Chongqing 400016, China.
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Tamashiro H, Kinoshita S, Okamoto T, Urushidani N, Abo M. Effect of baseline brain activity on response to low-frequency rTMS/intensive occupational therapy in poststroke patients with upper limb hemiparesis: a near-infrared spectroscopy study. Int J Neurosci 2018; 129:337-343. [DOI: 10.1080/00207454.2018.1536053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hiroaki Tamashiro
- Department of Rehabilitation Medicine, Nishi-Hiroshima Rehabilitation Hospital, Hiroshima, Japan
| | - Shoji Kinoshita
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
- Department of Rehabilitation Medicine, Aomori Shintoshi Hospital, Aomori, Aomori, Japan
| | - Takatsugu Okamoto
- Department of Rehabilitation Medicine, Nishi-Hiroshima Rehabilitation Hospital, Hiroshima, Japan
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Naoki Urushidani
- Department of Rehabilitation Medicine, Nishi-Hiroshima Rehabilitation Hospital, Hiroshima, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
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Hanafi MH, Kassim NK, Ibrahim AH, Adnan MM, Ahmad WMAW, Idris Z, Latif LA. Cortical Modulation After Two Different Repetitive Transcranial Magnetic Stimulation Protocols in Similar Ischemic Stroke Patients. Malays J Med Sci 2018; 25:116-125. [PMID: 30918461 PMCID: PMC6422591 DOI: 10.21315/mjms2018.25.2.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/25/2018] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Stroke is one of the leading causes of mortality and morbidity in Malaysia. Repetitive transcranial magnetic stimulation (rTMS) is one of the new non-invasive modality to enhance the motor recovery in stroke patients. OBJECTIVES This pilot study compared the motor evoked potential (MEP) changes using different settings of rTMS in the post-ischemic stroke patient. The goal of the study is to identify effect sizes for a further trial and evaluate safety aspects. METHODS Eight post-stroke patients with upper limb hemiparesis for at least six months duration were studied in a tertiary hospital in Northeast Malaysia. Quasi experimental design was applied and the participants were randomised into two groups using software generated random numbers. One of the two settings: i) inhibitory setting, or ii) facilitatory setting have been applied randomly during the first meeting. The motor evoked potential (MEP) were recorded before and after application of the rTMS setting. A week later, a similar procedure will be repeated but using different setting than the first intervention. Each patient will serve as their own control. Repeated measures ANOVA test was applied to determine the effect sizes for both intervention through the options of partial eta-squared (η2 p). RESULT The study observed large effect sizes (η2 p > 0.14) for both rTMS settings in the lesion and non-lesion sides. For safety aspects, no minor or major side effects associated with the rTMS was reported by the participants. CONCLUSIONS The partial eta square of MEP value for both rTMS settings (fascilitatory and inhibitory) in both lesion and non-lesion sides represents large effect sizes. We recommend further trial to increase number of sample in order to study the effectiveness of both settings in ischemic stroke patient. Our preliminary data showed both settings may improve the MEP of the upper extremity in the ischemic stroke patient. No significant improvement noted when comparing both settings.
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Affiliation(s)
- Muhammad Hafiz Hanafi
- School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
- Center for Neuroscience Services and Research, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Nur Karyatee Kassim
- School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Al Hafiz Ibrahim
- School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Munirah Mohd Adnan
- School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | | | - Zamzuri Idris
- School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
- Center for Neuroscience Services and Research, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Lydia Abdul Latif
- Department of Rehabilitation Medicine 2, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Forogh B, Ahadi T, Nazari M, Sajadi S, Abdul Latif L, Akhavan Hejazi SM, Raissi G. The Effect of Repetitive Transcranial Magnetic Stimulation on Postural Stability After Acute Stroke: A Clinical Trial. Basic Clin Neurosci 2017; 8:405-411. [PMID: 29167727 PMCID: PMC5691172 DOI: 10.18869/nirp.bcn.8.5.405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Balance impairment is a common problem and a major cause of motor disability after stroke. Therefore, this study aimed to investigate whether low-frequency repetitive Transcranial Magnetic Stimulation (rTMS) improves the postural balance problems in stroke patients. Methods: This randomized double blind clinical trial with 12 weeks follow-up was conducted on stroke patients. Treatment was carried with 1 Hz rTMS in contralateral brain hemisphere over the primary motor area for 20 minutes (1200 pulses) for 5 consecutive days. Static postural stability, Medical Research Council (MRC), Berg Balance Scale (BBS), and Fugl-Meyer assessments were evaluated immediately, 3 weeks and 12 weeks after intervention. Results: A total of 26 patients were enrolled (age range=53 to 79 years; 61.5% were male) in this study. Administering rTMS produced a significant recovery based on BBS (df=86, 7; F=7.4; P=0.01), Fugl-Meyer Scale (df=86, 7; F=8.7; P<0.001), MRC score (df=87, 7; F=2.9; P=0.01), and static postural stability (df=87, 7; F=9.8; P<0.001) during the 12 weeks follow-up. Conclusion: According to the findings, rTMS as an adjuvant therapy may improve the static postural stability, falling risk, coordination, motor recovery, and muscle strength in patients with stroke.
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Affiliation(s)
- Bijan Forogh
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Tehran, Iran
| | - Tannaz Ahadi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Tehran, Iran
| | - Maryam Nazari
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Tehran, Iran
| | - Simin Sajadi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Tehran, Iran
| | - Lydia Abdul Latif
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Seyed Majid Akhavan Hejazi
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gholamreza Raissi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Tehran, Iran
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Crosson B, McGregor KM, Nocera JR, Drucker JH, Tran SM, Butler AJ. The relevance of aging-related changes in brain function to rehabilitation in aging-related disease. Front Hum Neurosci 2015; 9:307. [PMID: 26074807 PMCID: PMC4444823 DOI: 10.3389/fnhum.2015.00307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/12/2015] [Indexed: 12/29/2022] Open
Abstract
The effects of aging on rehabilitation of aging-related diseases are rarely a design consideration in rehabilitation research. In this brief review we present strong coincidental evidence from these two fields suggesting that deficits in aging-related disease or injury are compounded by the interaction between aging-related brain changes and disease-related brain changes. Specifically, we hypothesize that some aphasia, motor, and neglect treatments using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) in stroke patients may address the aging side of this interaction. The importance of testing this hypothesis and addressing the larger aging by aging-related disease interaction is discussed. Underlying mechanisms in aging that most likely are relevant to rehabilitation of aging-related diseases also are covered.
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Affiliation(s)
- Bruce Crosson
- Department of Veterans Affairs Rehabilitation Research and Development Center of Excellence for Visual and Neurocognitive Rehabilitation (151R), Atlanta VA Medical Center Decatur, GA, USA ; Department of Neurology, Emory University Atlanta, GA, USA ; Department of Psychology, Georgia State University Atlanta, GA, USA ; School of Health and Rehabilitation Sciences, University of Queensland Brisbane, Qld, Australia
| | - Keith M McGregor
- Department of Veterans Affairs Rehabilitation Research and Development Center of Excellence for Visual and Neurocognitive Rehabilitation (151R), Atlanta VA Medical Center Decatur, GA, USA ; Department of Neurology, Emory University Atlanta, GA, USA
| | - Joe R Nocera
- Department of Veterans Affairs Rehabilitation Research and Development Center of Excellence for Visual and Neurocognitive Rehabilitation (151R), Atlanta VA Medical Center Decatur, GA, USA ; Department of Neurology, Emory University Atlanta, GA, USA
| | - Jonathan H Drucker
- Department of Veterans Affairs Rehabilitation Research and Development Center of Excellence for Visual and Neurocognitive Rehabilitation (151R), Atlanta VA Medical Center Decatur, GA, USA ; Department of Neurology, Emory University Atlanta, GA, USA ; Department of Psychology, Emory University Atlanta, GA, USA
| | - Stella M Tran
- Department of Veterans Affairs Rehabilitation Research and Development Center of Excellence for Visual and Neurocognitive Rehabilitation (151R), Atlanta VA Medical Center Decatur, GA, USA ; Department of Psychology, Georgia State University Atlanta, GA, USA
| | - Andrew J Butler
- Department of Veterans Affairs Rehabilitation Research and Development Center of Excellence for Visual and Neurocognitive Rehabilitation (151R), Atlanta VA Medical Center Decatur, GA, USA ; Department of Physical Therapy and School of Nursing and Health Professionals, Georgia State University Atlanta, GA, USA
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Reti IM, Schwarz N, Bower A, Tibbs M, Rao V. Transcranial magnetic stimulation: A potential new treatment for depression associated with traumatic brain injury. Brain Inj 2015; 29:789-97. [PMID: 25950260 DOI: 10.3109/02699052.2015.1009168] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Each year, more than 1.7 million Americans suffer a traumatic brain injury (TBI) and the lifetime prevalence of major depressive disorder following TBI is between 25-50%. There are no validated established strategies to treat TBI depression. Repetitive transcranial magnetic stimulation (rTMS) is a novel putative treatment option for post-TBI depression, which, compared with standard pharmacological agents, may provide a more targeted treatment with fewer side-effects. However, TBI is associated with an increased risk of both early and late spontaneous seizures, a significant consideration in evaluating rTMS as a potential treatment for TBI depression. Whilst the risk of seizure from rTMS is low, underlying neuropathology may somewhat increase that risk. REVIEW This review focuses on the safety aspects of rTMS in TBI patients. The authors review why low frequency rTMS might be less likely to trigger a seizure than high frequency rTMS and propose low frequency rTMS as a safer option in TBI patients. Because there is little data on the safety of rTMS in TBI, the authors also review the safety of rTMS in patients with other brain pathology. CONCLUSION It is concluded that pilot safety and tolerability studies should be first conducted in persons with TBI and neuropsychiatric comorbidities. These results could be used to help design larger randomized controlled trials.
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Affiliation(s)
- Irving M Reti
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University , Baltimore, MD , USA
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Thrane S, Cohen SM. Effect of Reiki therapy on pain and anxiety in adults: an in-depth literature review of randomized trials with effect size calculations. Pain Manag Nurs 2014; 15:897-908. [PMID: 24582620 PMCID: PMC4147026 DOI: 10.1016/j.pmn.2013.07.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 11/20/2022]
Abstract
The objective of this study was to calculate the effect of Reiki therapy for pain and anxiety in randomized clinical trials. A systematic search of PubMed, ProQuest, Cochrane, PsychInfo, CINAHL, Web of Science, Global Health, and Medline databases was conducted using the search terms pain, anxiety, and Reiki. The Center for Reiki Research also was examined for articles. Studies that used randomization and a control or usual care group, used Reiki therapy in one arm of the study, were published in 2000 or later in peer-reviewed journals in English, and measured pain or anxiety were included. After removing duplicates, 49 articles were examined and 12 articles received full review. Seven studies met the inclusion criteria: four articles studied cancer patients, one examined post-surgical patients, and two analyzed community dwelling older adults. Effect sizes were calculated for all studies using Cohen's d statistic. Effect sizes for within group differences ranged from d = 0.24 for decrease in anxiety in women undergoing breast biopsy to d = 2.08 for decreased pain in community dwelling adults. The between group differences ranged from d = 0.32 for decrease of pain in a Reiki versus rest intervention for cancer patients to d = 4.5 for decrease in pain in community dwelling adults. Although the number of studies is limited, based on the size Cohen's d statistics calculated in this review, there is evidence to suggest that Reiki therapy may be effective for pain and anxiety. Continued research using Reiki therapy with larger sample sizes, consistently randomized groups, and standardized treatment protocols is recommended.
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Affiliation(s)
- Susan Thrane
- University of Pittsburgh School of Nursing, Research in Cancer Survivorship, Supported by NINR (TNR011972A), 3500 Victoria Street, Victoria Building, Pittsburgh, PA 15261
| | - Susan M. Cohen
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Victoria Building, Pittsburgh, PA 15261
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Yamada N, Kakuda W, Kondo T, Mitani S, Shimizu M, Abo M. Local Muscle Injection of Botulinum Toxin Type A Synergistically Improves the Beneficial Effects of Repetitive Transcranial Magnetic Stimulation and Intensive Occupational Therapy in Post-Stroke Patients with Spastic Upper Limb Hemiparesis. Eur Neurol 2014; 72:290-8. [DOI: 10.1159/000365005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/02/2014] [Indexed: 11/19/2022]
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21
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Takekawa T, Kakuda W, Uchiyama M, Ikegaya M, Abo M. Brain perfusion and upper limb motor function: A pilot study on the correlation between evolution of asymmetry in cerebral blood flow and improvement in Fugl–Meyer Assessment score after rTMS in chronic post-stroke patients. J Neuroradiol 2014; 41:177-83. [DOI: 10.1016/j.neurad.2013.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/31/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
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Chen F, Qi Z, Luo Y, Hinchliffe T, Ding G, Xia Y, Ji X. Non-pharmaceutical therapies for stroke: mechanisms and clinical implications. Prog Neurobiol 2014; 115:246-69. [PMID: 24407111 PMCID: PMC3969942 DOI: 10.1016/j.pneurobio.2013.12.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/19/2013] [Accepted: 12/27/2013] [Indexed: 12/14/2022]
Abstract
Stroke is deemed a worldwide leading cause of neurological disability and death, however, there is currently no promising pharmacotherapy for acute ischemic stroke aside from intravenous or intra-arterial thrombolysis. Yet because of the narrow therapeutic time window involved, thrombolytic application is very restricted in clinical settings. Accumulating data suggest that non-pharmaceutical therapies for stroke might provide new opportunities for stroke treatment. Here we review recent research progress in the mechanisms and clinical implications of non-pharmaceutical therapies, mainly including neuroprotective approaches such as hypothermia, ischemic/hypoxic conditioning, acupuncture, medical gases and transcranial laser therapy. In addition, we briefly summarize mechanical endovascular recanalization devices and recovery devices for the treatment of the chronic phase of stroke and discuss the relative merits of these devices.
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Affiliation(s)
- Fan Chen
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, Beijing 100053, China
| | - Zhifeng Qi
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, Beijing 100053, China
| | - Yuming Luo
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, Beijing 100053, China
| | - Taylor Hinchliffe
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Medical School at Houston, Houston, TX 77030, USA
| | - Guanghong Ding
- Shanghai Research Center for Acupuncture and Meridian, Shanghai 201203, China
| | - Ying Xia
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Medical School at Houston, Houston, TX 77030, USA.
| | - Xunming Ji
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, Beijing 100053, China.
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Kondo T, Kakuda W, Yamada N, Shimizu M, Abo M. Effects of repetitive transcranial magnetic stimulation and intensive occupational therapy on motor neuron excitability in poststroke hemiparetic patients: a neurophysiological investigation using F-wave parameters. Int J Neurosci 2014; 125:25-31. [PMID: 24564818 DOI: 10.3109/00207454.2014.897706] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The combination protocol of repetitive transcranial magnetic stimulation (RTMS) and intensive occupational therapy (OT) improves motor function of the paretic upper limb in poststroke patients. However, the effect of RTMS/OT on motor neuron excitability remains to be investigated. The purpose of this study was to determine the effect of 15-day application of RTMS/OT on motor neuron excitability in such patients using neurophysiological studies including F-wave parameter measurements. SUBJECTS AND METHODS Ten poststroke patients with spastic upper limb hemiparesis were studied (mean age: 57.4 ± 8.1 years, ± SD). Patients were hospitalized for 15 days to receive RTMS/OT. One session of 40-min low-frequency RTMS and two sessions of 120-min intensive OT were provided daily. Neurophysiological studies including F-wave parameters measurements were performed on the days of admission/discharge. Motor function and spasticity of the affected upper limb were evaluated on the same time points. RESULTS RTMS/OT significantly improved motor function of the affected upper limb. RTMS/OT decreased the modified Ashworth scale (MAS) in the affected upper limb (p < 0.05), but did not change F-wave frequency in either upper limb. However, both F-mean/M ratio and F-max/M ratio significantly decreased in the affected upper limb (all p < 0.05). CONCLUSIONS The 15-day protocol of LF-RTMS/OT produced significant reduction of motor neuron excitability. RTMS/OT can potentially produce significant reduction in upper limb spasticity in the affected upper limb, although this finding should be confirmed in a larger number of patients.
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Abo M, Kakuda W, Momosaki R, Harashima H, Kojima M, Watanabe S, Sato T, Yokoi A, Umemori T, Sasanuma J. Randomized, Multicenter, Comparative Study of NEURO versus CIMT in Poststroke Patients with Upper Limb Hemiparesis: The NEURO-VERIFY Study. Int J Stroke 2013; 9:607-12. [DOI: 10.1111/ijs.12100] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 04/16/2013] [Indexed: 11/30/2022]
Abstract
Background Many poststroke patients suffer functional motor limitation of the affected upper limb, which is associated with diminished health-related quality of life. Aims The aim of this study is to conduct a randomized, multicenter, comparative study of low-frequency repetitive transcranial magnetic stimulation combined with intensive occupational therapy, NEURO (NovEl intervention Using Repetitive TMS and intensive Occupational therapy) versus constraint-induced movement therapy in poststroke patients with upper limb hemiparesis. Methods In this randomized controlled study of NEURO and constraint-induced movement therapy, 66 poststroke patients with upper limb hemiparesis were randomly assigned at 2:1 ratio to low-frequency repetitive transcranial magnetic stimulation plus occupational therapy (NEURO group) or constraint-induced movement therapy (constraint-induced movement therapy group) for 15 days. Fugl–Meyer Assessment and Wolf Motor Function Test and Functional Ability Score of Wolf Motor Function Test were used for assessment. Results No differences in patients' characteristics were found between the two groups at baseline. The Fugl–Meyer Assessment score was significantly higher in both groups after the 15-day treatment compared with the baseline. Changes in Fugl–Meyer Assessment scores and Functional Ability Score of Wolf Motor Function Test were significantly higher in the NEURO group than in the constraint-induced movement therapy group, whereas the decrease in the Wolf Motor Function Test log performance time was comparable between the two groups (changes in Fugl–Meyer Assessment score, NEURO: 5·39 ± 4·28, constraint-induced movement therapy: 3·09 ± 4·50 points; mean ± standard error of the mean; P < 0·05) (changes in Functional Ability Score of Wolf Motor Function Test, NEURO: 3·98 ± 2·99, constraint-induced movement therapy: 2·09 ± 2·96 points; P < 0·05). Conclusions The results of the 15-day rehabilitative protocol showed the superiority of NEURO relative to constraint-induced movement therapy; NEURO improved the motion of the whole upper limb and resulted in functional improvement in activities of daily living.
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Affiliation(s)
- Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Tokyo General Hospital, Tokyo, Japan
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Tokyo General Hospital, Tokyo, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroaki Harashima
- Department of Rehabilitation Medicine, Tokyo General Hospital, Tokyo, Japan
| | - Miki Kojima
- Department of Rehabilitation Medicine, Tokyo General Hospital, Tokyo, Japan
| | - Shigeto Watanabe
- Department of Rehabilitation Medicine, Tokyo General Hospital, Tokyo, Japan
| | - Toshihiro Sato
- Department of Rehabilitation Medicine, Tokyo General Hospital, Tokyo, Japan
| | - Aki Yokoi
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takuma Umemori
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Jinichi Sasanuma
- Department of Rehabilitation Medicine, Tokyo General Hospital, Tokyo, Japan
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Yamada N, Kakuda W, Senoo A, Kondo T, Mitani S, Shimizu M, Abo M. Functional cortical reorganization after low-frequency repetitive transcranial magnetic stimulation plus intensive occupational therapy for upper limb hemiparesis: evaluation by functional magnetic resonance imaging in poststroke patients. Int J Stroke 2013; 8:422-9. [PMID: 23692672 DOI: 10.1111/ijs.12056] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low-frequency repetitive transcranial magnetic stimulation of the nonlesional hemisphere combined with occupational therapy significantly improves motor function of the affected upper limb in poststroke hemiparetic patients, but the recovery mechanism remains unclear. AIMS To investigate the recovery mechanism using functional magnetic resonance imaging. METHODS Forty-seven poststroke hemiparetic patients were hospitalized to receive 12 sessions of 40-min low-frequency repetitive transcranial magnetic stimulation over the nonlesional hemisphere and daily occupational therapy for 15 days. Motor function was evaluated with the Fugl-Meyer Assessment and Wolf Motor Function Test. The functional magnetic resonance imaging with motor tasks was performed at admission and discharge. The laterality index of activated voxel number in Brodmann areas 4 and 6 on functional magnetic resonance imaging was calculated (laterality index range of -1 to +1). Patients were divided into two groups based on functional magnetic resonance imaging findings before the intervention: group 1: patients who showed bilateral activation (n = 27); group 2: patients with unilateral activation (n = 20). RESULTS Treatment resulted in improvement in Fugl-Meyer Assessment and Wolf Motor Function Test in the two groups (P < 0·01). The treatment also resulted in a significant increase in laterality index in group 1 (P < 0·05), suggesting a shift in activated voxels to the lesional hemisphere. Patients of group 2 showed a significant increase in lesional hemisphere activation (P < 0·05). CONCLUSIONS The results of serial functional magnetic resonance imaging indicated that our proposed treatment can induce functional cortical reorganization, leading to motor functional recovery of the affected upper limb. Especially, it seems that neural activation in the lesional hemisphere plays an important role in such recovery in poststroke hemiparetic patients.
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Abo M. [Repetitive transcranial magnetic stimulation and rehabilitation]. Rinsho Shinkeigaku 2013; 23:1264-1266. [PMID: 24291951 DOI: 10.5692/clinicalneurol.53.1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
NEURO (NovEl intervention Using Repetitive TMS and intensive Occupational therapy) have been recently reported to be clinically beneficial for post-stroke patients with upper limb hemiparesis. We confirmed the safety and feasibility of the protocol in 1,008 post-stroke patients from different institutions, and identify predictors of the clinical response to the treatment. And in our randomized controlled study of NEURO and constraint-induced movement therapy, NEURO showed the superiority of NEURO relative to constraint-induced movement therapy; NEURO improved the motion of the whole upper limb and resulted. We have investigated the recovery mechanism using electrophysiological examination and functional magnetic resonance imaging. Low-frequency rTMS applied to the non-lesional hemisphere in post-stroke patients significantly decreased the F-wave frequency and amplitude in the affected upper limb, suggesting that this modality has an anti-spastic effect in post-stroke patients. Serial functional magnetic resonance imaging indicated that our proposed treatment can induce functional cortical reorganization, leading to motor functional recovery of the affected upper limb. Especially, it seems that neural activation in the lesional hemisphere plays an important role in such recovery in poststroke hemiparetic patients.
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Affiliation(s)
- Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine
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