1. Cortical and spinal excitability changes after repetitive transcranial magnetic stimulation combined to physiotherapy in stroke spastic patients
- Author
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Nathália Serrano Lucena Amaral, Labibe Mara Pinel Frederico, Kátia Monte-Silva, Silvana Carla Barros Galvão, Alberto Galvão de Moura Filho, Maíra Izzadora Souza Carneiro, Rebeka Borba Costa dos Santos, Daniele Piscitelli, dos Santos, R, Galvao, S, Frederico, L, Amaral, N, Carneiro, M, de Moura Filho, A, Piscitelli, D, and Monte-Silva, K
- Subjects
Male ,medicine.medical_specialty ,Neurology ,Upper extremity ,medicine.medical_treatment ,Modified Ashworth scale ,Stimulation ,Dermatology ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Physical Therapy Modalitie ,Spastic ,medicine ,Humans ,030212 general & internal medicine ,Stroke ,Physical Therapy Modalities ,H-reflex ,Aged ,business.industry ,Stroke Rehabilitation ,General Medicine ,Middle Aged ,Spinal cord ,medicine.disease ,Combined Modality Therapy ,Transcranial Magnetic Stimulation ,Transcranial magnetic stimulation ,Psychiatry and Mental health ,medicine.anatomical_structure ,Treatment Outcome ,Spinal Cord ,Muscle Spasticity ,Cortical Excitability ,Physical therapy ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Human - Abstract
Objective: Repetitive Transcranial Magnetic Stimulation (rTMS) has been used to treat post-stroke upper limb spasticity (ULS) in addition to physiotherapy (PT). To determine whether rTMS associated with PT modulates cortical and spinal cord excitability as well as decreases ULS of post-stroke patients. Methods: Twenty chronic patients were randomly assigned to either the intervention group-1 Hz rTMS on the unaffected hemisphere and PT, or control group-sham stimulation and PT, for ten sessions. Before and after sessions, ULS was measured using the modified Ashworth scale and cortical excitability using the output intensity of the magnetic stimulator (MSO). The spinal excitability was measured by the Hmax/Mmax ratio of the median nerve at baseline, at the end of treatment, and at the 4-week follow-up. Results: The experimental group showed at the end of treatment an enhancement of cortical excitability, i.e., lower values of MSO, compared to control group (p = 0.044) and to baseline (p = 0.028). The experimental group showed a decreased spinal cord excitability at the 4-week follow-up compared to control group (p = 0.021). ULS decreased by the sixth session in the experimental group (p < 0.05). Conclusion: One-hertz rTMS associated with PT increased the unaffected hemisphere excitability, decreased spinal excitability, and reduced post-stroke ULS.
- Published
- 2019