Article

Both low-frequency repetitive transcranial magnetic stimulation
(rTMS) and intensive occupational therapy (OT) have been recently reported to be
clinically beneficial for post-stroke patients with upper limb hemiparesis. Based
on these reports, we developed an inpatient combination protocol of these two
modalities for the treatment of such patients. The aims of this pilot study were
to confirm the safety and feasibility of the protocol in a large number of
patients from different institutions, and identify predictors of the clinical
response to the treatment. The study subjects were 204 post-stroke
patients with upper limb hemiparesis (mean age at admission 58.5 +/- 13.4 years,
mean time after stroke 5.0 +/- 4.5 years, +/- SD) from five institutions in
Japan. During 15-day hospitalization, each patient received 22 treatment sessions
of 20-min low-frequency rTMS and 120-min intensive OT daily. Low-frequency rTMS
of 1 Hz was applied to the contralesional hemisphere over the primary motor area.
The intensive OT, consisting of 60-min one-to-one training and 60-min
self-exercise, was provided after the application of low-frequency rTMS.
Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) were performed
serially. The physiatrists and occupational therapists involved in this study
received training prior to the study to standardize the therapeutic protocol.
RESULTS: All patients completed the protocol without any adverse effects. The FMA
score increased and WMFT log performance time decreased significantly at
discharge, relative to the respective values at admission (change in FMA score:
median at admission, 47 points; median at discharge, 51 points; p < 0.001. change
in WMFT log performance time: median at admission, 3.23; median at discharge,
2.51; p < 0.001). These changes were persistently seen up to 4 weeks after
discharge in 79 patients. Linear regression analysis found no significant
relationship between baseline parameters and indexes of improvement in motor
function. CONCLUSIONS: The 15-day inpatient rTMS plus OT protocol is a safe,
feasible, and clinically useful neurorehabilitative intervention for post-stroke
patients with upper limb hemiparesis. The response to the treatment was not
influenced by age or time after stroke onset. The efficacy of the intervention
should be confirmed in a randomized controlled study including a control group.

Langue : ANGLAIS