Repetitive transcranial magnetic stimulation-induced corticomotor excitability and associated motor skill acquisition in chronic stroke

• Published in: Stroke (1970) Vol. 37; no. 6; pp. 1471 - 1476
• Main Authors: KIM, Yun-Hee, YOU, Sung H, KO, Myoung-Hwan, PARK, Ji-Won, KWANG HO LEE, SUNG HO JANG, YOO, Woo-Kyoung, HALLETT, Mark
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-06-2006
• Subjects: Biological and medical sciences; Brain Mapping; Chronic Disease; Cross-Over Studies; Evoked Potentials, Motor; Female; Hand - physiopathology; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Investigative techniques, diagnostic techniques (general aspects); Learning; Male; Medical sciences; Middle Aged; Motor Cortex - physiopathology; Motor Skills; Movement; Nervous system; Nervous system (semeiology, syndromes); Neurology; Neuronal Plasticity; Paresis - physiopathology; Practice (Psychology); Psychomotor Performance; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Single-Blind Method; Stroke - physiopathology; Stroke - psychology; Stroke - therapy; Transcranial Magnetic Stimulation - methods; Vascular diseases and vascular malformations of the nervous system; Vascular disease; Stroke; Chronic; Nervous system diseases; Central nervous system disease; Excitability; Cardiovascular disease; transcranial magnetic stimulation; Cerebrovascular disease; Cerebral disorder; motor activity
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000221233.55497.51

Although there is some early evidence showing the value of repetitive transcranial magnetic stimulation (rTMS) in stroke rehabilitation, the therapeutic effect of high-frequency rTMS, along with the physiology of rTMS-induced corticomotor excitability supporting motor learning in stroke, has not been established. This study investigated high-frequency rTMS-induced cortical excitability and the associated motor skill acquisition in chronic stroke patients.
Fifteen patients with chronic hemiparetic stroke (13 men; mean age 53.5 years) practiced a complex, sequential finger motor task using their paretic fingers either after 10 Hz or sham rTMS over the contralateral primary motor cortex (M1). Both the changes in the behavior and corticomotor excitability before and after the intervention were examined by measuring the movement accuracy, the movement time, and the motor-evoked potential (MEP) amplitude. A separate repeated-measures ANOVA and correlation statistics were used to determine the main and interaction effects as well as relationship between the changes in the behavioral and corticomotor excitability.
High-frequency rTMS resulted in a significantly larger increase in the MEP amplitude than the sham rTMS (P<0.01), and the plastic change was positively associated with an enhanced motor performance accuracy (P<0.05).
High-frequency rTMS of the affected motor cortex can facilitate practice-dependent plasticity and improve the motor learning performance in chronic stroke victims.