Effects of high frequency repetitive transcranial magnetic stimulation with physical healthy exercise in stroke

Abstract

It has been recently demonstrated high frequency repetitive transcranial magnetic stimulation (HF-rTMS) can improve motor function after stroke. However, there is no study that tested the synergetic effects of physical therapy to HF-rTMS in clinical settings. We therefore investigated the effect of physical healthy exercise (PHE) on paretic arm combined with HF-rTMS in stroke patients. All patients underwent HF-rTMS on contralesional hemisphere for 15 minutes and PHE on paretic arm. The cortical excitability by the amplitude and latency of motor evoked potential (MEP) were measured. We also evaluated arm function using Box and Block, arm reach, 9-hole pegboard, and grip force tests. We found for the first time significant differences of MEP between pre- and post-intervention. HF-rTMS with PHE had a tendency to induce a decrease in MEP amplitude on the nonparetic hand whereas it led to an increment in MEP amplitude in the paretic hand. In particular, the Box and Block, power grip, and arm reach tests showed improvement through every session. Furthermore, motor function and MEP were correlated especially on paretic side. These results indicate PHE with HF-rTMS partially improves arm function after stroke which may support additional effect to rehabilitation in stroke patients.