High-frequency repetitive transcranial magnetic stimulation for stroke patients lower extremity function: primary motor cortex versus cerebellar stimulation. A randomized controlled trial.

BACKGROUND

Transcranial magnetic stimulation (TMS) has recently been used to great effect to enhance the motor function and performance of patients with stroke by modifying cerebral cortex excitability. But few studies have directly compared the effectiveness of stimulating the M1 and cerebellar regions in using rTMS to improve lower limb motor function in stroke patients.

AIM: To assess the effectiveness of high-frequency (HF) repetitive TMS (rTMS) applied to the primary motor cortex (M1) versus the cerebellar region for improving lower limb dsyfunction and maintaining balance ability in people suffering from stroke.

DESIGN

Randomized, double-blind, sham controlled clinical trial.

SETTING

Department of rehabilitation medicine in a general hospital.

POPULATION: Patients with stroke with first unilateral lesions were enrolled in the study.

METHODS

Seventy-one patients were randomly allocated to sham stimulation group, acerebellum group, and M1 group. Each group received rTMS alongside their routine rehabilitation. The M1 group received stimulation to the affected lower limb motor cortex, while the cerebellum group received stimulation to the contralesional cerebellum. The sham stimulation group had a non-stimulating setup. The stimulation parameters were as follows: the stimulation intensity of 80%RMTand frequency of 10 Hz. The stimulation lasted 20 minutes per session, comprising 3 seconds of stimulation followed by a 17-second interval. This equated to 1,800 pulses per day, five times a session for two weeks.

RESULTS

Before the intervention, no significant differences was found in terms of the Fugl-Meyer Assessment for the Lower Extremities (FAM-LE), the Berg Balance Scale (BBS), movement trajectory length, center of movement trajectory area and the Modified Barthel Index (MBI) (P>0.05). Two weeks later, however, the M1 group and cerebellar group demonstrated statistically significant improvements in the FAM-LE, BBS and MBI (P<0.05). The cerebellar and M1 groups outperformed the sham stimulation group in terms of movement trajectory measures (P<0.05), with the cerebellar group achieving the best results.

CONCLUSIONS

Both M1 and cerebellar HF stimulation have been shown to play a positive role in the functionality of the lower limbs and the ability of balance in stroke patients, with cerebellar stimulation proving to be especially efficacious in the amelioration of balance.

CLINICAL REHABILITATION IMPACT: M1 and cerebellar can improve stroke patient lower limb function, but cerebellar maybe a more perfect region for improving balance function compare with M1.