Background
Low-frequency
repetitive transcranial magnetic stimulation (rTMS) over the
contralesional motor cortex (M1) has demonstrated beneficial effects on
motor recovery, but evidence among patients with subacute stroke is
lacking. We aimed to investigate whether 1-Hz rTMS over the
contralesional M1 versus sham rTMS could improve arm function in
patients with subacute ischemic stroke when combined with rehabilitative
motor training.
Methods
In
total, 77 patients who were within 90 days after their first-ever
ischemic stroke were enrolled and randomly allocated to either real (n =
40) or sham rTMS (n = 37). We delivered 1-Hz 30-minute active or sham
rTMS before each daily 30-minute occupational therapy sessions over a
2-week period. The primary endpoint was changes in the Box and Block
Test (BBT) score immediately after the end of treatment (EOT). Secondary
analyses assessed changes in Fugl-Meyer assessment, Finger Tapping Test
(FTT), Brunnstrom stage, and grip strength.
Clinical Trial Registration
ClinialTrials.gov (NCT02082015).
Results
Changes in BBT immediately after the end of treatment did not differ significantly between the 2 groups (P
= .267). Subgroup analysis according to cortical involvement revealed
that real rTMS resulted in improvements in BBT at 1 month after EOT
(17.4 ± 9.8 real vs 10.9 ± 10.3 sham; P = .023) and Brunnstrom stage of the hand immediately after EOT (0.6 ± 0.5 real vs 0.2 ± 0.5 sham; P = .023), only in the group without cortical involvement.
Conclusion
The
effects of real and sham rTMS did not differ significantly among
patients within 3 months poststroke. The location of stroke lesions
should be considered for future clinical trials.
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