Our Experience with rTMS in a Stroke

Abstract

Background Repetitive Transcranial Magnetic Stimulation (r-TMS), a non-invasive brain stimulation method, appears promising in augmenting post-stroke recovery and requires further evaluation. Aims and Objective To study the effect of r-TMS treatment on motor function in patients with strokes of different duration and types. Methods A prospective, single center study was conducted to study the effect of bilateral motor cortex rTMS treatment in 100 consecutive patients with either ischemic or hemorrhagic stroke of any duration. Measured outcomes were changes in NIHSS, MRC grading for motor power, MAS (modified Ashworth scale) for spasticity and mRS (modified Rankin Score) from baseline to follow-up visit at 90 days. Paired T test was used for comparing the outcomes. Results 77% subjects were males, 82% had ischemic stroke, median age was 58.5 years, and median NIHSS score was 11. We observed favorable changes in outcome measures after treatment. mRS < = 2 at 90 days was observed in 85.71% of patients with acute stroke, 64.51% of subacute and 55.88% of chronic strokes (p value < 0.002). Acute stroke had higher rates of limb power improvement (94.28%) than subacute (70.96%) or chronic strokes (41.17%) (p value = < 0.01). Post-stroke spasticity reduction was also observed after rTMS. Patients with infarcts or hemorrhages had no significant differences. No significant adverse events were seen. Conclusion rTMS appears to be safe in our study population and could be effectively delivered at different time points to augment post-stroke motor recovery.