Ipsilesional 5 Hz Repetitive Transcranial Magnetic Stimulation for Motor Dysfunction in Subacute Intracerebral Hemorrhage: An Exploratory Trial.

OBJECTIVE

To explore whether ipsilesional 5 Hz repetitive transcranial magnetic stimulation (rTMS) therapy can improve motor function in patients with intracerebral hemorrhage (ICH) and observe any adverse reactions.

DESIGN

A 4-week randomized, controlled, single-blind (evaluator) trial with a 1-month follow-up.

SETTING

A tertiary hospital rehabilitation center.

PARTICIPANTS

Forty-nine patients with first ICH were recruited and randomly separated into an experimental (n=25; 19 men, 6 women) or control group (n=24; 17 men, 7 women), with age range of 30 to 75 years, and mean duration after hemorrhage onset of 47 (range 17-86) days.

INTERVENTIONS: The experimental group received ipsilesional 5 Hz rTMS therapy and conventional rehabilitation training. The hot spot of the abductor pollicis brevis and tibialis anterior muscles on the affected hemisphere of the brain received 1500 pulses of stimulation each day, for a total of 3000 pulses. The stimulations applied to the affected abductor pollicis brevis and tibialis anterior hot spots were separated by >2 hours. The stimulation frequency was 5 Hz, each sequence lasting 2 seconds, with a sequence interval of 5 seconds, for a total duration of 36 minutes every day. The control group only received conventional rehabilitation training.

MAIN OUTCOME MEASURES: The primary endpoint was the change in Brunnstrom stage. Secondary endpoints included Fugl-Meyer Assessment, Barthel Index, and Berg Balance Scale. All assessments were performed at baseline, after intervention (day 29) and 1 month after intervention (day 60).

RESULTS

Improvements over baseline in all scores at day 29 and 60 were significantly greater in the 5 Hz rTMS group than in the control group. No significant side effects were reported during the experiment and 1 month after the experiment.

CONCLUSIONS

Applying 5 Hz high-frequency rTMS to the affected hemisphere within 3 months after the onset of ICH appears safe and may significantly improve motor function and activities of daily living.