|
1
|
Dos Santos RBC, Galvão SCB, Frederico LMP, Amaral NSL, Carneiro MIS, de Moura Filho AG, Piscitelli D, Monte-Silva K. Cortical and spinal excitability changes after repetitive transcranial magnetic stimulation combined to physiotherapy in stroke spastic patients. Neurol Sci 2019; 40:1199-1207. [PMID: 30852696 DOI: 10.1007/s10072-019-03765-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 02/14/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Repetitive Transcranial Magnetic Stimulation (rTMS) has been used to treat post-stroke upper limb spasticity (ULS) in addition to physiotherapy (PT). To determine whether rTMS associated with PT modulates cortical and spinal cord excitability as well as decreases ULS of post-stroke patients. METHODS Twenty chronic patients were randomly assigned to either the intervention group-1 Hz rTMS on the unaffected hemisphere and PT, or control group-sham stimulation and PT, for ten sessions. Before and after sessions, ULS was measured using the modified Ashworth scale and cortical excitability using the output intensity of the magnetic stimulator (MSO). The spinal excitability was measured by the Hmax/Mmax ratio of the median nerve at baseline, at the end of treatment, and at the 4-week follow-up. RESULTS The experimental group showed at the end of treatment an enhancement of cortical excitability, i.e., lower values of MSO, compared to control group (p = 0.044) and to baseline (p = 0.028). The experimental group showed a decreased spinal cord excitability at the 4-week follow-up compared to control group (p = 0.021). ULS decreased by the sixth session in the experimental group (p < 0.05). CONCLUSION One-hertz rTMS associated with PT increased the unaffected hemisphere excitability, decreased spinal excitability, and reduced post-stroke ULS.
Collapse
Affiliation(s)
- Rebeka Borba Costa Dos Santos
- Applied Neuroscience Laboratory, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil
| | - Silvana Carla Barros Galvão
- Applied Neuroscience Laboratory, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil
| | - Labibe Mara Pinel Frederico
- Applied Neuroscience Laboratory, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil
| | - Nathália Serrano Lucena Amaral
- Applied Neuroscience Laboratory, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil
| | - Maíra Izzadora Souza Carneiro
- Applied Neuroscience Laboratory, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil
| | - Alberto Galvão de Moura Filho
- Laboratory of Kinesiology and Functional Assessment, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil
| | - Daniele Piscitelli
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Kátia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil.
| |
Collapse
|