Effectiveness of repetitive transcranial magnetic stimulation (rTMS) after acute stroke: A one-year longitudinal randomized trial.

Abstract

To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on motor recovery after stroke using a prospective, double-blind, randomized, sham-controlled study. Patients with unilateral subcortical infarction in the middle cerebral artery territory within 1week after onset were enrolled. The patients were randomly divided into an rTMS treatment group and a sham group. We performed high-frequency rTMS or sham rTMS on the two groups. Motor functional scores were assessed pre- and post-rTMS/sham rTMS and at 1month, 3months, 6months, and 1year after stroke onset. The scores included the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Fugl-Meyer Assessment Upper Limb/Lower Limb (FMA-UL/LL), modified Rank Score (mRS), and the resting motor threshold (RMT) of the hemiplegic limb. At baseline, no significant differences were found between the two groups for motor functional scores. On the second day after rTMS treatment, score improvements of the NIHSS, BI, FMA-UL in the real treatment group were more significant than those in the sham group. In addition, similar results were obtained at 1month. However, at 3months, 6months, and 1year after onset, no significant differences in improvement were observed between the two groups, except for the FMA-UL score improvement. rTMS facilitates motor recovery of acute stroke patients, and the effect can last to 1month, except the function improvement on upper extremities could last for 1year. A single course of rTMS in the acute stage may induce the improvement of upper extremities function lasted for 1year.