MRI evaluation of motor function recovery by rTMS and intensive occupational therapy and changes in the activity of...

Purpose/aim: An intervention that combines low-frequency repetitive transcranial magnetic stimulation and intensive occupational therapy can improve brain function in post-stroke patients with motor paralysis. The purpose of the present study is examined motor function recovery by repetitive transcranial magnetic stimulation and intensive occupational therapy and changes in the activity of motor cortex based on magnetic resonance imaging data.Materials and methods: In total, we assessed 30 patients with post-stroke upper extremity paralysis who were hospitalized for 12 sessions of low-frequency repetitive transcranial magnetic stimulation over the lesion-free hemisphere plus daily occupational therapy for 15 days. Imaging analysis was performed using 3-dimensional T1-weighted image and functional magnetic resonance imaging. Hemispheric dominance was assessed by functional magnetic resonance imaging using the laterality index. In addition, Seed-based functional connectivity analysis was used to evaluate functional connectivity between the precentral gyrus of the affected side and other areas.Results: A positive correlation was found between laterality index before intervention and the Brunnstrom recovery stage for hand/fingers (p < 0.05). The intervention resulted in significantly higher functional connectivity between the precentral gyrus of the affected side and that of the healthy side (false discovery rate corrected p < 0.05).Conclusions: We clarified that the recovery of motor function by intervention with low-frequency repetitive transcranial magnetic stimulation and occupational therapy and the increase of functional connectivity between the precentral gyrus on the affected side and the healthy side are related. These results facilitate prognostic predictions and evidence-based medical care.