Abstract
Objective: To investigate high-frequency repetitive transcranial magnetic stimulation (rTMS)−induced cortical plasticity associated with motor skill acquisition in chronic stroke patients. Design: Before-after study. Setting: University hospital. Participants: 6 patients with chronic hemiparetic stroke (3 men, 3 women; mean age, 54.5±8.62y). Interventions: We applied rTMS over their contralateral primary motor cortex for 10 days. We applied 50 pulses at 10Hz of rTMS for a period of 5 seconds with a resting motor threshold of 80%. As soon as the rTMS was finished, the patients practiced a complex sequential finger motor task (training block) using their paretic fingers for 50 seconds. The rTMS and motor training block was repeated 10 times for each training session. Main Outcome Measures: Movement accuracy and time before and after the rTMS training, and also at 1 week and 1 month after cessation of the training for the measurement of motor performance, and functional magnetic resonance imaging (fMRI) before and after the intervention for the determination of neuroplastic changes. Results: High-frequency rTMS accompanied by motor training showed improved motor performances in both movement accuracy and movement time (P<.05). The behavioral effects were retained until 1 month after cessation of the training. fMRI data showed decreased activities of the ipsilateral primary motor cortex and increased activity of the contralateral motor cortex and the ipsilateral cerebellum after receiving rTMS and motor training. Conclusions: High-frequency rTMS can facilitate practice-dependent plasticity in chronic stroke patients.
Published Version
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