Article

Noninvasive cortical stimulation could represent an add-on treatment
to enhance motor recovery after stroke. However, its clinical value, including
anticipated size and duration of the treatment effects, remains largely unknown.
OBJECTIVE: The authors designed a small semi-randomized clinical trial to explore
whether long-lasting clinically important gains can be achieved by adding theta
burst stimulation (TBS), a form of repetitive transcranial magnetic stimulation
(TMS), to a rehabilitation program for the hand. METHODS: A total of 41 chronic
stroke patients received excitatory TBS to the ipsilesional hemisphere or
inhibitory TBS to the contralesional hemisphere in 2 centers; each active group
was compared with a group receiving sham TBS. TBS was followed by physical
therapy for 10 working days. Patients and therapists were blinded to the type of
TBS. Primary outcome measures (9-hole Peg Test [9HPT], Jebsen Taylor Test [JTT],
and grip and pinch-grip dynamometry) were assessed 4, 30, and 90 days post
treatment. The clinically important difference was defined as 10% of the maximum
score. RESULTS: There were no differences between the active treatment and sham
groups in any of the outcome measures. All patients achieved small sustainable
improvements--9HPT, 5% of maximum (confidence interval [CI] = 3%-7%); JTT, 5.7%
(CI = 3%-8%); and grip strength, 6% (CI = 2%-10%)--all below the defined clinically important level. CONCLUSIONS: Cortical stimulation did not augment the
gains from a late rehabilitation program. The effect size anticipated by the
authors was overestimated. These results can improve the design of future work on
therapeutic uses of TMS.

Langue : ANGLAIS