[Repetitive transcranial magnetic stimulation and rehabilitation]

NEURO (NovEl intervention Using Repetitive TMS and intensive Occupational therapy) have been recently reported to be clinically beneficial for post-stroke patients with upper limb hemiparesis. We confirmed the safety and feasibility of the protocol in 1,008 post-stroke patients from different institutions, and identify predictors of the clinical response to the treatment. And in our randomized controlled study of NEURO and constraint-induced movement therapy, NEURO showed the superiority of NEURO relative to constraint-induced movement therapy; NEURO improved the motion of the whole upper limb and resulted. We have investigated the recovery mechanism using electrophysiological examination and functional magnetic resonance imaging. Low-frequency rTMS applied to the non-lesional hemisphere in post-stroke patients significantly decreased the F-wave frequency and amplitude in the affected upper limb, suggesting that this modality has an anti-spastic effect in post-stroke patients. Serial functional magnetic resonance imaging indicated that our proposed treatment can induce functional cortical reorganization, leading to motor functional recovery of the affected upper limb. Especially, it seems that neural activation in the lesional hemisphere plays an important role in such recovery in poststroke hemiparetic patients.