Seiji Etoh, Tomokazu Noma, Keiko Ikeda, Yuiko Jonoshita, Atsuko Ogata, Shuji Matsumoto, Megumi Shimodozono, Kazumi Kawahira
Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences3930-7 Makizono-cho, Kagoshima 899-6603, Japan. E-mail: etohs@m2.kufm.kagoshima-u.ac.jp
DOI: 10.2340/16501977-1175

Objective: To investigate whether multiple sessions of 1-Hz repetitive transcranial magnetic stimulation (rTMS) facilitates the effect of repetitive facilitation exercises on hemiplegic upper-limb function in chronic stroke patients.
Design: Randomized double-blinded crossover study.
Patients: Eighteen patients with hemiplegia of the upper limb.
Methods: Patients were assigned to 2 groups: a motor-before-sham rTMS group, which performed motor rTMS sessions for 2 weeks followed by sham rTMS sessions for 2 weeks; or a motor-following-sham rTMS group, which performed sham rTMS sessions for 2 weeks followed by motor rTMS sessions for 2 weeks. Patients received 1-Hz rTMS to the unaffected motor cortex for 4 min and performed repetitive facilitation exercises for 40 min during motor rTMS sessions. The Fugl-Meyer Assessment, Action Research Arm Test (ARAT) and Simple Test for Evaluating Hand Function were used to evaluate upper-limb function. The Modified Ashworth Scale and F-wave were measured to evaluate spasticity.
Results: Motor function improved significantly during the motor, but not sham, rTMS sessions. ARAT score gains were 1. 5 (0–4. 0) (median, interquartile range) during the motor rTMS session, and 0 (–0. 8–1. 8) during the sham rTMS session (p = 0. 04). Spasticity did not significantly change during either session.
Conclusion: Multiple sessions of 1-Hz rTMS facilitated the effects of repetitive facilitation exercises in improving motor function of the affected upper limb, but did not change spasticity.