Effects of high- and low-frequency repetitive transcranial magnetic stimulation on motor recovery in early stroke patients: Evidence from a randomized controlled trial with clinical, neurophysiological and functional imaging assessments

Juan Du, Fang Yang, Jianping Hu, Jingze Hu, Qiang Xu, Nathan Cong, Qirui Zhang, Ling Liu, Dante Mantini, Zhiqiang Zhang, Guangming Lu, Xinfeng Liu

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) can modulate cortical excitability, and may be beneficial for motor recovery after stroke. However, the neuroplasticity effects of rTMS have not been thoroughly investigated in the early stage after stroke.

OBJECTIVE: To comprehensively assess the effects of high- and low-frequency repetitive transcranial magnetic stimulations on motor recovery in early stroke patients, using a randomized controlled trial based on clinical, neurophysiological and functional imaging assessments.

METHODS: Sixty hospitalized, first-ever ischemic stroke patients (within 2 weeks after stroke) with motor deficits were randomly allocated to receive, in addition to standard physical therapy, five consecutive sessions of either: (1) High-frequency (HF) rTMS at 10 Hz over the ipsilesional primary motor cortex (M1); (2) Low-frequency (LF) rTMS at 1 Hz over the contralesional M1; (3) sham rTMS. The primary outcome measure was a motor impairment score (Upper Extremity Fugl-Meyer) evaluated at baseline, after rTMS intervention, and at 3-month follow-up. Cortical excitability and functional magnetic resonance imaging (fMRI) data were obtained within 24 h before and after rTMS intervention. Analyses of variance were conducted to compare the recovery effects among the three rTMS groups, assessed using clinical, neurophysiological and fMRI tests.

RESULTS: Motor improvement was significantly larger in the two rTMS groups than in the control group. The HF-rTMS group showed significantly increased cortical excitability and motor-evoked fMRI activation in ipsilesional motor areas, whereas the LF-rTMS group had significantly decreased cortical excitability and motor-evoked fMRI activation in contralesional motor areas. Activity in ipsilesional motor cortex significantly correlated with motor function, after intervention as well as at 3-month follow-up.

CONCLUSION: HF- and LF-rTMS can both improve motor function by modulating motor cortical activation in the early phase of stroke.

Original languageEnglish
Pages (from-to)101620
JournalNeuroImage: Clinical
Volume21
DOIs
Publication statusPublished - 2019

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Transcranial Magnetic Stimulation
Randomized Controlled Trials
Stroke
Motor Cortex
Magnetic Resonance Imaging
Neuronal Plasticity
Upper Extremity
Analysis of Variance

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Effects of high- and low-frequency repetitive transcranial magnetic stimulation on motor recovery in early stroke patients : Evidence from a randomized controlled trial with clinical, neurophysiological and functional imaging assessments. / Du, Juan; Yang, Fang; Hu, Jianping; Hu, Jingze; Xu, Qiang; Cong, Nathan; Zhang, Qirui; Liu, Ling; Mantini, Dante; Zhang, Zhiqiang; Lu, Guangming; Liu, Xinfeng.

In: NeuroImage: Clinical, Vol. 21, 2019, p. 101620.

Research output: Contribution to journalArticle

Du, Juan ; Yang, Fang ; Hu, Jianping ; Hu, Jingze ; Xu, Qiang ; Cong, Nathan ; Zhang, Qirui ; Liu, Ling ; Mantini, Dante ; Zhang, Zhiqiang ; Lu, Guangming ; Liu, Xinfeng. / Effects of high- and low-frequency repetitive transcranial magnetic stimulation on motor recovery in early stroke patients : Evidence from a randomized controlled trial with clinical, neurophysiological and functional imaging assessments. In: NeuroImage: Clinical. 2019 ; Vol. 21. pp. 101620.
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title = "Effects of high- and low-frequency repetitive transcranial magnetic stimulation on motor recovery in early stroke patients: Evidence from a randomized controlled trial with clinical, neurophysiological and functional imaging assessments",
abstract = "BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) can modulate cortical excitability, and may be beneficial for motor recovery after stroke. However, the neuroplasticity effects of rTMS have not been thoroughly investigated in the early stage after stroke.OBJECTIVE: To comprehensively assess the effects of high- and low-frequency repetitive transcranial magnetic stimulations on motor recovery in early stroke patients, using a randomized controlled trial based on clinical, neurophysiological and functional imaging assessments.METHODS: Sixty hospitalized, first-ever ischemic stroke patients (within 2 weeks after stroke) with motor deficits were randomly allocated to receive, in addition to standard physical therapy, five consecutive sessions of either: (1) High-frequency (HF) rTMS at 10 Hz over the ipsilesional primary motor cortex (M1); (2) Low-frequency (LF) rTMS at 1 Hz over the contralesional M1; (3) sham rTMS. The primary outcome measure was a motor impairment score (Upper Extremity Fugl-Meyer) evaluated at baseline, after rTMS intervention, and at 3-month follow-up. Cortical excitability and functional magnetic resonance imaging (fMRI) data were obtained within 24 h before and after rTMS intervention. Analyses of variance were conducted to compare the recovery effects among the three rTMS groups, assessed using clinical, neurophysiological and fMRI tests.RESULTS: Motor improvement was significantly larger in the two rTMS groups than in the control group. The HF-rTMS group showed significantly increased cortical excitability and motor-evoked fMRI activation in ipsilesional motor areas, whereas the LF-rTMS group had significantly decreased cortical excitability and motor-evoked fMRI activation in contralesional motor areas. Activity in ipsilesional motor cortex significantly correlated with motor function, after intervention as well as at 3-month follow-up.CONCLUSION: HF- and LF-rTMS can both improve motor function by modulating motor cortical activation in the early phase of stroke.",
author = "Juan Du and Fang Yang and Jianping Hu and Jingze Hu and Qiang Xu and Nathan Cong and Qirui Zhang and Ling Liu and Dante Mantini and Zhiqiang Zhang and Guangming Lu and Xinfeng Liu",
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TY - JOUR

T1 - Effects of high- and low-frequency repetitive transcranial magnetic stimulation on motor recovery in early stroke patients

T2 - Evidence from a randomized controlled trial with clinical, neurophysiological and functional imaging assessments

AU - Du, Juan

AU - Yang, Fang

AU - Hu, Jianping

AU - Hu, Jingze

AU - Xu, Qiang

AU - Cong, Nathan

AU - Zhang, Qirui

AU - Liu, Ling

AU - Mantini, Dante

AU - Zhang, Zhiqiang

AU - Lu, Guangming

AU - Liu, Xinfeng

N1 - Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

PY - 2019

Y1 - 2019

N2 - BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) can modulate cortical excitability, and may be beneficial for motor recovery after stroke. However, the neuroplasticity effects of rTMS have not been thoroughly investigated in the early stage after stroke.OBJECTIVE: To comprehensively assess the effects of high- and low-frequency repetitive transcranial magnetic stimulations on motor recovery in early stroke patients, using a randomized controlled trial based on clinical, neurophysiological and functional imaging assessments.METHODS: Sixty hospitalized, first-ever ischemic stroke patients (within 2 weeks after stroke) with motor deficits were randomly allocated to receive, in addition to standard physical therapy, five consecutive sessions of either: (1) High-frequency (HF) rTMS at 10 Hz over the ipsilesional primary motor cortex (M1); (2) Low-frequency (LF) rTMS at 1 Hz over the contralesional M1; (3) sham rTMS. The primary outcome measure was a motor impairment score (Upper Extremity Fugl-Meyer) evaluated at baseline, after rTMS intervention, and at 3-month follow-up. Cortical excitability and functional magnetic resonance imaging (fMRI) data were obtained within 24 h before and after rTMS intervention. Analyses of variance were conducted to compare the recovery effects among the three rTMS groups, assessed using clinical, neurophysiological and fMRI tests.RESULTS: Motor improvement was significantly larger in the two rTMS groups than in the control group. The HF-rTMS group showed significantly increased cortical excitability and motor-evoked fMRI activation in ipsilesional motor areas, whereas the LF-rTMS group had significantly decreased cortical excitability and motor-evoked fMRI activation in contralesional motor areas. Activity in ipsilesional motor cortex significantly correlated with motor function, after intervention as well as at 3-month follow-up.CONCLUSION: HF- and LF-rTMS can both improve motor function by modulating motor cortical activation in the early phase of stroke.

AB - BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) can modulate cortical excitability, and may be beneficial for motor recovery after stroke. However, the neuroplasticity effects of rTMS have not been thoroughly investigated in the early stage after stroke.OBJECTIVE: To comprehensively assess the effects of high- and low-frequency repetitive transcranial magnetic stimulations on motor recovery in early stroke patients, using a randomized controlled trial based on clinical, neurophysiological and functional imaging assessments.METHODS: Sixty hospitalized, first-ever ischemic stroke patients (within 2 weeks after stroke) with motor deficits were randomly allocated to receive, in addition to standard physical therapy, five consecutive sessions of either: (1) High-frequency (HF) rTMS at 10 Hz over the ipsilesional primary motor cortex (M1); (2) Low-frequency (LF) rTMS at 1 Hz over the contralesional M1; (3) sham rTMS. The primary outcome measure was a motor impairment score (Upper Extremity Fugl-Meyer) evaluated at baseline, after rTMS intervention, and at 3-month follow-up. Cortical excitability and functional magnetic resonance imaging (fMRI) data were obtained within 24 h before and after rTMS intervention. Analyses of variance were conducted to compare the recovery effects among the three rTMS groups, assessed using clinical, neurophysiological and fMRI tests.RESULTS: Motor improvement was significantly larger in the two rTMS groups than in the control group. The HF-rTMS group showed significantly increased cortical excitability and motor-evoked fMRI activation in ipsilesional motor areas, whereas the LF-rTMS group had significantly decreased cortical excitability and motor-evoked fMRI activation in contralesional motor areas. Activity in ipsilesional motor cortex significantly correlated with motor function, after intervention as well as at 3-month follow-up.CONCLUSION: HF- and LF-rTMS can both improve motor function by modulating motor cortical activation in the early phase of stroke.

U2 - 10.1016/j.nicl.2018.101620

DO - 10.1016/j.nicl.2018.101620

M3 - Article

C2 - 30527907

VL - 21

SP - 101620

JO - NeuroImage: Clinical

JF - NeuroImage: Clinical

SN - 2213-1582

ER -