http://nnr.sagepub.com/content/26/8/976.abstract?etoc
Abstract
Background. Noninvasive cortical stimulation could represent an add-on treatment to enhance motor recovery after stroke. However, its
clinical value, including anticipated size and duration of the treatment effects, remains largely unknown. Objective.
The authors designed a small semi-randomized clinical trial to explore
whether long-lasting clinically important gains can
be achieved by adding theta burst stimulation
(TBS), a form of repetitive transcranial magnetic stimulation (TMS), to a
rehabilitation
program for the hand. Methods. A total of
41 chronic stroke patients received excitatory TBS to the ipsilesional
hemisphere or inhibitory TBS to the contralesional
hemisphere in 2 centers; each active group was
compared with a group receiving sham TBS. TBS was followed by physical
therapy
for 10 working days. Patients and therapists were
blinded to the type of TBS. Primary outcome measures (9-hole Peg Test
[9HPT],
Jebsen Taylor Test [JTT], and grip and pinch-grip
dynamometry) were assessed 4, 30, and 90 days post treatment. The
clinically
important difference was defined as 10% of the
maximum score. Results. There were no differences between the
active treatment and sham groups in any of the outcome measures. All
patients achieved
small sustainable improvements—9HPT, 5% of maximum
(confidence interval [CI] = 3%-7%); JTT, 5.7% (CI = 3%-8%); and grip
strength,
6% (CI = 2%-10%)—all below the defined clinically
important level. Conclusions. Cortical stimulation did not augment the gains from a late rehabilitation program. The effect size anticipated by the authors
was overestimated. These results can improve the design of future work on therapeutic uses of TMS.
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