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Neurological Sciences
Published in: Neurological Sciences 6/2019

01-06-2019 | Stroke | Original Article

Cortical and spinal excitability changes after repetitive transcranial magnetic stimulation combined to physiotherapy in stroke spastic patients

Authors: Rebeka Borba Costa dos Santos, Silvana Carla Barros Galvão, Labibe Mara Pinel Frederico, Nathália Serrano Lucena Amaral, Maíra Izzadora Souza Carneiro, Alberto Galvão de Moura Filho, Daniele Piscitelli, Kátia Monte-Silva

Published in: Neurological Sciences | Issue 6/2019

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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.
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Metadata
Title
Cortical and spinal excitability changes after repetitive transcranial magnetic stimulation combined to physiotherapy in stroke spastic patients
Authors
Rebeka Borba Costa dos Santos
Silvana Carla Barros Galvão
Labibe Mara Pinel Frederico
Nathália Serrano Lucena Amaral
Maíra Izzadora Souza Carneiro
Alberto Galvão de Moura Filho
Daniele Piscitelli
Kátia Monte-Silva
Publication date
01-06-2019
Publisher
Springer International Publishing
Published in
Neurological Sciences / Issue 6/2019
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-019-03765-y

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