P 219. Navigated repeated transcranial magnetic stimulation in stroke rehabilitation (randomized blind sham-controlled study), Preliminary results: safety and tolerability

• Published in: Clinical neurophysiology 2013-10, Vol.124 (10), p.e169-e169
• Main Authors: Piradov, M, Chernikova, L, Tanashyan, M, Kadykov, A, Chervyakov, A, Nazarova, M, Gnezditsky, V, Konovalov, R, Savitskaya, N, Fedin, P, Suslin, A, Glebov, M, Dobrynina, L
• Format: Article
• Language: English
• Subjects: Neurology
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2013.04.296

Stroke is one of the most disabling diseases of the nervous system. Search for new approaches to stroke rehabilitation is an important clinical challenge. Among several noninvasive brain stimulation techniques repetitive transcranial magnetic stimulation (rTMS) demonstrated beneficial effect for motor recovery after stroke. Now there are two main therapeutic strategies of brain stimulation for motor rehabilitation in stroke patients: up-regulation of excitability of the primary motor cortex (M1) of the affected hemisphere (HS) with high-frequency stimulation and/or inhibition of the M1 of the unaffected HS with low-frequency stimulation. The transcranial magnetic stimulation with MRI navigation (nTMS) permits to take into account individual brain anatomy and to repeat stimulation focally. So, we supposed that for rTMS of the primary motor areas for stroke rehabilitation neuronavigation also may improve the results. The randomized blind sham-controlled study of repetitive navigated TMS of primary motor cortex for motor stroke rehabilitation was started. Design We plan to include 100 patients in this research. Primary Outcome Measures: evidence of clinically definite ischemic stroke confirmed by CT or MRI; emergence of epileptic seizures. Secondary Outcome Measures: evaluation of the clinical condition of the patients. Clinical condition of patients including motor deficit was assessed with a battery of scales: Fugl-Meyer scale, Ashworth scale, Perry scale, test with 10 meters walking, Bartel index, Renkin scale. Patients were randomly assigned to one of the four groups in the study: 1. Experimental: Low-frequency: 1 Hz, 100% Motor threshold (MO), 20 min, unaffected hemisphere. 2. Experimental: High frequency stimulation: 10 Hz, 80% MT, 2 s-stimulation, 58 s-rest-8 session; affected hemisphere. 3. Experimental: Both hemispheric stimulation: low-frequency to unaffected hemisphere than high-frequency to affect hemisphere. 4. Sham stimulation group: standard treatment and sham transcranial magnetic stimulation. Patients were not aware of the stimulation regimen. Inclusion Criteria: stroke from 8 days to 3 years in a pool of carotid arteries. NIHSS from 5 to 20 points. Rankin scale at most 3. Exclusion Criteria: implanted pacemaker, intracardiac catheters, electronic pumps, pregnancy or possibility of pregnancy in women of reproductive age; presence of metallic elements or implants in the head region; epilepsy or seizures in anamnesis. It has been recruited 15 p