Application of combined 6-Hz primed low-frequency rTMS and intensive occupational therapy for upper limb hemiparesis after stroke

Introduction: The purpose of this study was to clarify the safety, feasibility and efficacy of 6-Hz primed low-frequency repetitive transcranial magnetic stimulation (rTMS) applied with intensive occupational therapy (OT) for upper limb hemiparesis after stroke. Subjects and methods: Eleven patients with history of stroke and upper limb hemiparesis (age at intervention: 61.0 +/- 13.7 years, time after stroke onset: 70.2 +/- 39.8 months) were studied. Each patient received 22 sessions of 6-Hz primed low-frequency rTMS (10-min 6-Hz priming stimulation followed by 20-min low-frequency rTMS of 1-Hz) applied to the non-lesional hemisphere plus intensive OT comprising 60-min one-to-one training and 60-min self-training during 15-day hospitalization. The motor function of the affected upper limb was evaluated by Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) on the days of admission and discharge. Results: All patients completed the 15-day protocol without any adverse effects. The treatment increased the FMA score (from 42.2 +/- 6.9 to 45.6 +/- 7.2 points, p < 0.005) and shortened the log performance time of WMFT (from 3.26 +/- 1.21 to 2.81 +/- 1.26 sec, p < 0.05). Conclusions: The 15-day protocol of 6-Hz primed low-frequency rTMS combined with intensive OT seems safe and a potentially useful therapeutic modality for upper limb hemiparesis after stroke.