Article

PURPOSE: To investigate the effect of low-frequency repetitive transcranial
magnetic stimulation (rTMS) on lower extremity (LE) spasticity, motor function
and motor neurone excitability in chronic stroke patients. METHOD: This study was
a randomised sham-controlled cross-over trial with 1-week follow-up. A total of
20 post-stroke patients were randomised to receive active (n = 10) or sham (n =
10) rTMS. Fourteen of them (7 in each group) crossed over to the sham or active
rTMS after a washout period of 1 month. Interventions consist of five consecutive
daily sessions of active or sham rTMS to the unaffected lower extremity motor
area (1000 pulses; 1 Hz; 90% of the tibialis anterior motor threshold). Outcome
measures were modified modified ashworth scale (MMAS), the H-reflex, lower
extremity section of Fugl-Mayer assessment (LE-FMA) and timed UP and GO (TUG)
test. All outcomes were measured at three levels in each intervention period:
pre- and post-intervention and 1-week follow-up. RESULTS: Friedman's test
revealed significant improvement in MMAS score only after active rTMS. This
improvement lasted for one week after the active rTMS. Repeated measure analysis
of variance (ANOVA) showed significant time*intervention interaction for LE-FMA.
There are no differences between groups for the MMAS and LE-FMA. No significant
change in Hmax/Mmax ratio and TUG test was noted. CONCLUSION: Low-frequency rTMS
over the LE motor area can improve clinical measures of muscle spasticity and
motor function. More studies are needed to clarify the changes underlying this
improvement in spasticity. Implications for Rehabilitation Spasticity is a common
disorder and one of the causes of long-term disability after stroke. Physical
therapy modalities, oral medications, focal intervention and surgical procedures
have been used for spasticity reduction. Beneficial effect of the repetitive
transcranial magnetic stimulation (rTMS) for post-stroke upper extremity
spasticity reduction and motor function improvement was demonstrated in previous
studies. This study shows amelioration of lower extremity spasticity and motor
function improvement after five daily sessions of inhibitory rTMS to the unaffected brain hemisphere which lasted for at least 1 week following the
intervention.

Langue : ANGLAIS