Repetitive Transcranial Magnetic Stimulation of motor cortex after stroke: A focused review

Manuela Corti, Carolynn Patten, William Triggs

Research output: Contribution to journalReview article

80 Citations (Scopus)

Abstract

Repetitive Transcranial Magnetic Stimulation (rTMS) is known to modulate cortical excitability and has thus been suggested to be a therapeutic approach for improving the efficacy of rehabilitation for motor recovery after stroke. In addition to producing effects on cortical excitability, stroke may affect the balance of transcallosal inhibitory pathways between motor primary areas in both hemispheres: the affected hemisphere (AH) may be disrupted not only by the infarct itself but also by the resulting asymmetric inhibition from the unaffected hemisphere, further reducing the excitability of the AH. Conceptually, therefore, rTMS could be used therapeutically to restore the balance of interhemispheric inhibition after stroke. rTMS has been used in two ways: low-frequency stimulation (≤1 Hz) to the motor cortex of the unaffected hemisphere to reduce the excitability of the contralesional hemisphere or high-frequency stimulation (>1 Hz) to the motor cortex of the AH to increase excitability of the ipsilesional hemisphere. The purpose of this systematic review is to collate evidence regarding the safety and efficacy of high-frequency rTMS to the motor cortex of the AH. The studies included investigated the concurrent effects of rTMS on the excitability of corticospinal pathways and upper-limb motor function in adults after stroke. This review suggests that rTMS applied to the AH is a safe technique and could be considered an effective approach for modulating brain function and contributing to motor recovery after stroke. Although the studies included in this review provide important information, double-blinded, sham-controlled Phase II and Phase III clinical trials with larger sample sizes are needed to validate this novel therapeutic approach.

Original languageEnglish (US)
Pages (from-to)254-270
Number of pages17
JournalAmerican Journal of Physical Medicine and Rehabilitation
Volume91
Issue number3
DOIs
StatePublished - Mar 1 2012
Externally publishedYes

Fingerprint

Transcranial Magnetic Stimulation
Motor Cortex
Stroke
Phase III Clinical Trials
Upper Extremity
Sample Size
Rehabilitation
Safety
Brain
Therapeutics

Keywords

  • Interhemispheric Competition
  • Recovery
  • Rehabilitation
  • Repetitive Transcranial Magnetic Stimulation
  • Stroke

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Repetitive Transcranial Magnetic Stimulation of motor cortex after stroke : A focused review. / Corti, Manuela; Patten, Carolynn; Triggs, William.

In: American Journal of Physical Medicine and Rehabilitation, Vol. 91, No. 3, 01.03.2012, p. 254-270.

Research output: Contribution to journalReview article

@article{92d45d168e76462fb99640ce5ae48a8a,
title = "Repetitive Transcranial Magnetic Stimulation of motor cortex after stroke: A focused review",
abstract = "Repetitive Transcranial Magnetic Stimulation (rTMS) is known to modulate cortical excitability and has thus been suggested to be a therapeutic approach for improving the efficacy of rehabilitation for motor recovery after stroke. In addition to producing effects on cortical excitability, stroke may affect the balance of transcallosal inhibitory pathways between motor primary areas in both hemispheres: the affected hemisphere (AH) may be disrupted not only by the infarct itself but also by the resulting asymmetric inhibition from the unaffected hemisphere, further reducing the excitability of the AH. Conceptually, therefore, rTMS could be used therapeutically to restore the balance of interhemispheric inhibition after stroke. rTMS has been used in two ways: low-frequency stimulation (≤1 Hz) to the motor cortex of the unaffected hemisphere to reduce the excitability of the contralesional hemisphere or high-frequency stimulation (>1 Hz) to the motor cortex of the AH to increase excitability of the ipsilesional hemisphere. The purpose of this systematic review is to collate evidence regarding the safety and efficacy of high-frequency rTMS to the motor cortex of the AH. The studies included investigated the concurrent effects of rTMS on the excitability of corticospinal pathways and upper-limb motor function in adults after stroke. This review suggests that rTMS applied to the AH is a safe technique and could be considered an effective approach for modulating brain function and contributing to motor recovery after stroke. Although the studies included in this review provide important information, double-blinded, sham-controlled Phase II and Phase III clinical trials with larger sample sizes are needed to validate this novel therapeutic approach.",
keywords = "Interhemispheric Competition, Recovery, Rehabilitation, Repetitive Transcranial Magnetic Stimulation, Stroke",
author = "Manuela Corti and Carolynn Patten and William Triggs",
year = "2012",
month = "3",
day = "1",
doi = "10.1097/PHM.0b013e318228bf0c",
language = "English (US)",
volume = "91",
pages = "254--270",
journal = "American Journal of Physical Medicine and Rehabilitation",
issn = "0894-9115",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Repetitive Transcranial Magnetic Stimulation of motor cortex after stroke

T2 - A focused review

AU - Corti, Manuela

AU - Patten, Carolynn

AU - Triggs, William

PY - 2012/3/1

Y1 - 2012/3/1

N2 - Repetitive Transcranial Magnetic Stimulation (rTMS) is known to modulate cortical excitability and has thus been suggested to be a therapeutic approach for improving the efficacy of rehabilitation for motor recovery after stroke. In addition to producing effects on cortical excitability, stroke may affect the balance of transcallosal inhibitory pathways between motor primary areas in both hemispheres: the affected hemisphere (AH) may be disrupted not only by the infarct itself but also by the resulting asymmetric inhibition from the unaffected hemisphere, further reducing the excitability of the AH. Conceptually, therefore, rTMS could be used therapeutically to restore the balance of interhemispheric inhibition after stroke. rTMS has been used in two ways: low-frequency stimulation (≤1 Hz) to the motor cortex of the unaffected hemisphere to reduce the excitability of the contralesional hemisphere or high-frequency stimulation (>1 Hz) to the motor cortex of the AH to increase excitability of the ipsilesional hemisphere. The purpose of this systematic review is to collate evidence regarding the safety and efficacy of high-frequency rTMS to the motor cortex of the AH. The studies included investigated the concurrent effects of rTMS on the excitability of corticospinal pathways and upper-limb motor function in adults after stroke. This review suggests that rTMS applied to the AH is a safe technique and could be considered an effective approach for modulating brain function and contributing to motor recovery after stroke. Although the studies included in this review provide important information, double-blinded, sham-controlled Phase II and Phase III clinical trials with larger sample sizes are needed to validate this novel therapeutic approach.

AB - Repetitive Transcranial Magnetic Stimulation (rTMS) is known to modulate cortical excitability and has thus been suggested to be a therapeutic approach for improving the efficacy of rehabilitation for motor recovery after stroke. In addition to producing effects on cortical excitability, stroke may affect the balance of transcallosal inhibitory pathways between motor primary areas in both hemispheres: the affected hemisphere (AH) may be disrupted not only by the infarct itself but also by the resulting asymmetric inhibition from the unaffected hemisphere, further reducing the excitability of the AH. Conceptually, therefore, rTMS could be used therapeutically to restore the balance of interhemispheric inhibition after stroke. rTMS has been used in two ways: low-frequency stimulation (≤1 Hz) to the motor cortex of the unaffected hemisphere to reduce the excitability of the contralesional hemisphere or high-frequency stimulation (>1 Hz) to the motor cortex of the AH to increase excitability of the ipsilesional hemisphere. The purpose of this systematic review is to collate evidence regarding the safety and efficacy of high-frequency rTMS to the motor cortex of the AH. The studies included investigated the concurrent effects of rTMS on the excitability of corticospinal pathways and upper-limb motor function in adults after stroke. This review suggests that rTMS applied to the AH is a safe technique and could be considered an effective approach for modulating brain function and contributing to motor recovery after stroke. Although the studies included in this review provide important information, double-blinded, sham-controlled Phase II and Phase III clinical trials with larger sample sizes are needed to validate this novel therapeutic approach.

KW - Interhemispheric Competition

KW - Recovery

KW - Rehabilitation

KW - Repetitive Transcranial Magnetic Stimulation

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=84857195734&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857195734&partnerID=8YFLogxK

U2 - 10.1097/PHM.0b013e318228bf0c

DO - 10.1097/PHM.0b013e318228bf0c

M3 - Review article

C2 - 22042336

AN - SCOPUS:84857195734

VL - 91

SP - 254

EP - 270

JO - American Journal of Physical Medicine and Rehabilitation

JF - American Journal of Physical Medicine and Rehabilitation

SN - 0894-9115

IS - 3

ER -