Factors Associated With Upper Extremity Motor Recovery After Repetitive Transcranial Magnetic Stimulation in Stroke Patients

다국어 초록 (Multilingual Abstract)

Objective To determine factors associated with motor recovery of the upper extremity after repetitive transcranial magnetic stimulation (rTMS) treatment in stroke patients.Methods Twenty-nine patients with subacute stroke participated in this study. rTMS was applied to the hand motor cortex for 10 minutes at a 110% resting motor threshold and 10 Hz frequency for two weeks. We evaluated the biographical, neurological, clinical, and functional variables, in addition to the motor-evoked potential (MEP) response. The Manual Function Test (MFT) was performed before, immediately after, and two weeks after, the treatment. Patients were divided into a responder and non-responder group according to their respective improvements on the MFT. Data were compared between the two groups.Results Patients with exclusively subcortical stroke, absence of aphasia, the presence of a MEP response, high scores on the Mini-Mental Status Examination, Motricity Index arm score, Functional Independence Measure, and Functional Ambulatory Classification; and a shorter period from stroke onset to rTMS were found to be significantly associated with a response to rTMS. Conclusion The results of this study suggest that rTMS may have a greater effect on upper extremity motor recovery in stroke patients who have a MEP response, suffer an exclusively subcortical stroke, mild paresis, and have good functional status. Applying rTMS early would have additional positive effects in the patients with the identified characteristics.

참고문헌 (Reference)

1 정한영, "한글판 수정바델지수(K-MBI)의 개발: 뇌졸중 환자 대상의 다기관 연구" 대한재활의학회 31 (31): 283-297, 2007

2 Hoyer EH, "Understanding and enhancing motor recovery after stroke using transcranial magnetic stimulation" 29 : 395-409, 2011

3 Fleming MK, "The effect of coil type and navigation on the reliability of transcranial magnetic stimulation" 20 : 617-625, 2012

4 Lefaucheur JP., "Stroke recovery can be enhanced by using repetitive transcranial magnetic stimulation (rTMS)" 36 : 105-115, 2006

5 Rossi S, "Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research" 120 : 2008-2039, 2009

6 Yozbatiran N, "Safety and behavioral effects of high-frequency repetitive transcranial magnetic stimulation in stroke" 40 : 309-312, 2009

7 Kim YH, "Repetitive transcranial magnetic stimulationinduced corticomotor excitability and associated motor skill acquisition in chronic stroke" 37 : 1471-1476, 2006

8 Takeuchi N, "Repetitive transcranial magnetic stimulation over bilateral hemispheres enhances motor function and training effect of paretic hand in patients after stroke" 41 : 1049-1054, 2009

9 Corti M, "Repetitive transcranial magnetic stimulation of motor cortex after stroke: a focused review" 91 : 254-270, 2012

10 Malcolm MP, "Reliability of motor cortex transcranial magnetic stimulation in four muscle representations" 117 : 1037-1046, 2006

11 Miyamoto S, "Reliability and validity of the Manual Function Test in patients with stroke" 88 : 247-255, 2009

12 Loewen SC, "Predictors of stroke outcome using objective measurement scales" 21 : 78-81, 1990

13 Shimizu T, "Modulation of intracortical excitability for different muscles in the upper extremity:paired magnetic stimulation study with focal versus non-focal coils" 110 : 575-581, 1999

14 Emara T, "MRI can predict the response to therapeutic repetitive transcranial magnetic stimulation (rTMS) in stroke patients" 2 : 163-168, 2009

15 Chang WH, "Long-term effects of rTMS on motor recovery in patients after subacute stroke" 42 : 758-764, 2010

16 Khedr EM, "Long-term effect of repetitive transcranial magnetic stimulation on motor function recovery after acute ischemic stroke" 121 : 30-37, 2010

17 Norman GR, "Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation" 41 : 582-592, 2003

18 Nowak DA, "Interhemispheric competition after stroke: brain stimulation to enhance recovery of function of the affected hand" 23 : 641-656, 2009

19 Takeuchi N, "Inhibition of the unaffected motor cortex by 1 Hz repetitive transcranical magnetic stimulation enhances motor performance and training effect of the paretic hand in patients with chronic stroke" 40 : 298-303, 2008

20 Hsu WY, "Effects of repetitive transcranial magnetic stimulation on motor functions in patients with stroke: a meta-analysis" 43 : 1849-1857, 2012

21 Dafotakis M, "Effects of rTMS on grip force control following subcortical stroke" 211 : 407-412, 2008

22 Nowak DA, "Effects of low-frequency repetitive transcranial magnetic stimulation of the contralesional primary motor cortex on movement kinematics and neural activity in subcortical stroke" 65 : 741-747, 2008

23 Ameli M, "Differential effects of high-frequency repetitive transcranial magnetic stimulation over ipsilesional primary motor cortex in cortical and subcortical middle cerebral artery stroke" 66 : 298-309, 2009

24 Talelli P, "Arm function after stroke: neurophysiological correlates and recovery mechanisms assessed by transcranial magnetic stimulation" 117 : 1641-1659, 2006

25 Kohler F, "Agreement of functional independence measure item scores in patients transferred from one rehabilitation setting to another" 45 : 479-485, 2009

26 Fregni F, "A sham-controlled trial of a 5-day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients" 37 : 2115-2122, 2006