London, United Kingdom 2013 16 Rehabilitation and reorganisation after stroke B 15:30 - 15:40 Early inhibitory non-invasive brain stimulation of the unaffected hemisphere combined improves motor outcome in acute stroke C. Paquette1, M. Riegel2, C. Anglade3, J. Fung4, A. Thiel5 McGill University, Montreal, CANADA1,McGill Unvierstiy, Montreal, CANADA2, Univer-sity of Montreal, Montreal, CANADA3, McGill University, Montreal, CANADA4, McGill Uni-versity, Montreal, CANADA5 Background Contralesional primary motor cortex (M1) activity in the early recovery phase after stroke is caused by reduction of transcallosal inhibition from the affected hemisphere. Imaging stud-ies suggest that persisting contralesional M1 activity limits the extent of functional recovery. Down regulation of contralesional M1 activity may thus improve motor recovery by facilitating recruitment of motor networks in the affected hemisphere. We tested this hypothesis by mod-ulating contralesional M1 activity with non-invasive brain stimulation. We directly compared the effect of inhibitory repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and sham stimulation over unaffected M1 on upper limb motor re-covery in the early post-stroke phase. Methods Acute stroke subjects were randomized to receive either rTMS, tDCS or sham stimulation (Figure1). Subjects received up to 10 days (mean 8 days range 5-10) of double-blind inhibi-tory stimulation over unaffected M1, combined with physiotherapy (PT). On each day, subjects first received 15 minutes of real or sham rTMS followed by real or sham tDCS during the 40-60 minutes PT session. On average, treatment started 12 days range 6-21 after stroke onset. Mo-tor function was assessed with the Chedoke Arm and Hand Activity Inventory (CAHAI). Results CAHAI scores after treatment were significantly higher (p<0.05) for subjects in the rTMS group (19 SE 3 ) than for subjects receiving tDCS (11 SE 3) or sham stimulation (6 SE 3). CAHAI scores were similar at recruitment (p=0.994). Conclusion Our proof-of-principle study demonstrates the feasibility of a clinical double-blind controlled non-invasive brain stimulation trial in acute stroke patients. Inhibitory rTMS over unaffected M1 significantly improved upper limb motor recovery when given early after stroke. Results suggest that rTMS in acute stroke could increase rehabilitation potential and potentially shorten length of stay in rehabilitation clinics. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 147 15 Rehabilitation and reorganisation after stroke B 15:20 - 15:30 Navigated transcranial magnetic stimulation in rehabilitation of post-stroke hemiparesis D.A. Degterev1, I.V. Sidyakina2, T.V. Baidova3, O.R. Dobrushina4 Medical and Rehabilitation Center, Moscow, RUSSIAN FEDERATION1,Medical and Re-habilitation Center, Moscow, RUSSIAN FEDERATION2, Medical and Rehabilitation Center, Moscow, RUSSIAN FEDERATION3, Medical and Rehabilitation Center, Moscow, RUSSIAN FEDERATION4 Background: Rhythmic navigated transcranial magnetic stimulation (nTMS) affects cortical motor representations, interhemispheric interaction and balance between intracortical exci-tation and inhibition and thus is a feasible method of rehabilitation after stroke. Methods: We included 35 patients (24 men, 11 women) within 1 month to 2 years (mean 23.4 months) after stroke aged 50.2+/-13.1 years (range 23 to 75 years). Ischemic stroke was identified in 25 pa-tients, intracerebral hemorrhage was diagnosed in 10 patients. Patients were randomized into two groups, that did not significantly differ by gender, age and disease severity. Control group of 14 patients received basic treatment (physiotherapy, cyclic and free weights, muscle toning). 21 patients of the treatment group additionally received 15 procedures of nTMS. Manual mus-cle strength testing has shown that depth of hemiparesis in the treatment group was 2.9+/-1.3, in the control group – 2.8+/-1.4. NIHSS scored 18.1+/-5.7 and 17.7+/-5.3, Barthel index scored 19.5+/-5 and 20.1+/-5 respectively. In treatment group mapping of motor cortical representa-tion of the most affected limb was performed by «Nexstim» system, target points for precise stimulation were selected. Motor area of the unaffected hemisphere was stimulated with a fre-quency of 1 Hz per day, motor area of the affected hemisphere was stimulated with a frequency of 5 Hz per day. Results: Muscle strength in treatment group increased to 3.8+/-1.1 vs. 3.0+/- 0.9 in the control group (p=0.05), stroke severity by NIHSS score decreased to 14.1+/- 3.8 vs. 15.2+/-5.3 (p=0.09), Barthel Index increased to 41+/-8 vs. 35+/-5 (p=0.04). No complications of nTMS were observed. Conclusions: Rhythmic nTMS accelerates motor recovery after isch-emic stroke and intracerebral hemorrhage.
Karger_ESC London_2013
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