Sustained effects of high frequency repetitive transcranial magnetic stimulation (rTMS) and intensive physical therapy in patients with chronic stroke.

Akihiro Ikuta, Masaki Ishiguro, Shinya Okamoto, Kenya Wakaizumi, Kazuto Ishida, Yoshino Ueki, Aki Inagaki, Yoshihiko Horimoto
Purpose:

In this study, we aimed to disclose the outcomes of intensive physical therapy combined with lower limb rTMS regarding lower limb function and gait ability up to three months after treatment. 

Methods:

The subjects were 15 patients with post-stroke hemiplegia (>180 days after onset) who underwent lower limb rTMS at our hospital from 2019 to May 2024. Eighteen sessions were performed in 2 weeks, physical therapy immediately after rTMS established one session. The stimulation intensity of lower limb rTMS was set at 90% of the resting motor threshold (the minimum stimulation intensity that can induce MEP at the stimulation site), and 20 cycles (20 minutes) of high frequency (10 Hz) stimulation (10 sec stimulation, 50 sec rest) were targeted on the lower limb motor area. Motor function was assessed at baseline, just after treatment, one month after treatment, and three months after treatment. The outcomes were compared statistically by using repeated measures analysis of variance. The significance level was set at 5%. All subjects gave written informed consent on the study. The study was approved by the Ethics Committee of the hospital. 

Results:

There were significant increases in lower limb function (lower limb Fugl Meyer Assessment), walking ability (10 meter walk test, 6 Minutes Walking Test), and balance ability (Berg Balance Scale) at one month and three months after treatment compared with baseline. There were significant increases in lower limb function (lower limb Fugl Meyer Assessment), walking ability (10 meter walk test, 6 Minutes Walking Test), and balance ability (Berg Balance Scale) at one month and three months after treatment compared with baseline. 

Conclusion(s):

After the intensive physical therapy combined with rTMS, lower limb function, walking ability, and balance ability increased significantly at one month and three months after treatment compared with baseline, confirming that the effect was continued. It has been reported that physical ability reaches a plateau until 180 days after stroke onset. 

Implications:

 The present study suggests that intensive physiotherapy combined with rTMS treatment can improve and maintain lower limb function and walking ability in patients with stroke in the chronic phase.  

Funding acknowledgements:
nothing
Keywords:
rTMS
lower limb
chronic stroke
Primary topic:
Neurology: stroke
Second topic:
Neurology
Third topic:
Other
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Nagoya City Rehabilitation Center Hospital ethics committee of Nagoya City Rehabilitation Center Hospital
Provide the ethics approval number:
2020006
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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