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Case Reports
. 2023 Jan 27:14:1064718.
doi: 10.3389/fneur.2023.1064718. eCollection 2023.

Effects of sequential inhibitory and facilitatory repetitive transcranial magnetic stimulation on neurological and functional recovery of a patient with chronic stroke: A case report and literature review

Nan Chen  1 , Xiao Qiu  1 , Yan Hua  1 , Jian Hu  1 , Yulong Bai  1
Affiliations
Case Reports

Effects of sequential inhibitory and facilitatory repetitive transcranial magnetic stimulation on neurological and functional recovery of a patient with chronic stroke: A case report and literature review

Nan Chen et al. Front Neurol. .

Abstract

Background and purpose: The effects of conventional protocols of repetitive transcranial magnetic stimulation (rTMS) in the chronic phase of stroke are limited. This study aimed to apply the sequential inhibitory and facilitatory rTMS for upper limb motor dysfunction post-stroke to observe the efficacy and explore the possible neurophysiological mechanism. We hypothesize that this protocol would both enhance the excitability of affected M1 and promote connections among motor areas.

Case description: We reported a 55-year-old female patient with a 1-year chronic stroke and right-sided hemiplegia, who underwent the 14-session rTMS with seven sessions of low frequency (LF) and with seven sessions of high frequency (HF). Clinical scales mainly including Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), neurophysiological measures, and functional near-infrared spectroscopy (fNIRS) were assessed before (T0), at the midpoint (T1), and after the intervention (T2).

Outcomes: The patient exhibited post-intervention improvement in upper extremity function. There was increased excitability in the ipsilesional hemisphere and the opposite in the contralesional hemisphere. The interhemispheric inhibition (IHI) ratio increased from 2.70 to 10.81 and finally decreased to 1.34. Oxy-Hb signal was significantly decreased in affected M1 and mildly decreased in unaffected M1, while that of PMC and SMA on the affected side increased significantly.

Conclusion: The sequential inhibitory and facilitatory rTMS significantly promoted motor recovery in the patient. Related mechanisms include upregulation of excitability in the ipsilesional hemisphere, return of interhemispheric balance, and neuroplasticity-induced cortical reorganization.

Keywords: case report; motor recovery; neuroplasticity; stroke; transcranial magnetic stimulation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Pre- and post-therapy oxygenated hemoglobin (oxy-Hb) concentration measured by fNIRS during movement of the paretic upper limb in (A) M1 primary motor cortex, (B) PM premotor cortex, and (C) SMA supplementary motor area. (D) Example of hemodynamic response function (HRF) time series.
See this image and copyright information in PMC

References

    1. Campbell BCV, Khatri P. Stroke. Lancet. (2020) 396:129–42. 10.1016/S0140-6736(20)31179-X - DOI - PubMed
    1. Global regional and and national burden of neurological disorders 1990-2016: 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. (2019) 18:459–80. 10.1016/S1474-4422(18)30499-X - DOI - PMC - PubMed
    1. Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, et al. . Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev. (2014) 2014:CD010820. 10.1002/14651858.CD010820.pub2 - DOI - PMC - PubMed
    1. Peng Z, Zhou C, Xue S, Bai J, Yu S, Li X, et al. . Mechanism of repetitive transcranial magnetic stimulation for depression. Shanghai Arch Psychiatry. (2018) 30:84–92. 10.11919/j.issn.1002-0829.217047 - DOI - PMC - PubMed
    1. Chen R, Classen J, Gerloff C, Celnik P, Wassermann EM, Hallett M, et al. . Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology. (1997) 48:1398–403. 10.1212/WNL.48.5.1398 - DOI - PubMed

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