Neurorehabilitation with Transcranial Magnetic Stimulation and Peripheral Magnetic Stimulation for Post-stroke Motor Recovery: A Three-arm Randomized Controlled Trial

We conducted a three-arm randomized controlled trial to assess the efficacy of upper-extremity motor recovery among post-stroke patients. Subacute post-stroke patients (n = 69) were randomly assigned into 3 groups: rehabilitation alone, rehabilitation with repetitive transcranial magnetic stimulation, and rehabilitation with both repetitive transcranial magnetic stimulation and repetitive peripheral magnetic stimulation. For daily repetitive transcranial magnetic stimulation, 1,000 pulses were delivered to the hand area of the primary motor cortex in the ipsilesional hemisphere (10 trains of 10 Hz for 10 sec with a 15-sec intertrain interval). For daily repetitive peripheral magnetic stimulation, 1,000 pulses was delivered to the paretic-side forearm (40 trains of 25 Hz for 1 sec with a 2-sec intertrain interval). We also randomly assigned the patients into 3 groups based on their Brunnstrom recovery stages to make the Brunnstrom recovery stage distribution the same in each group. After 4 weeks of treatment, motor recovery was evaluated based on the changes in the patient's scores on the Fugl-Meyer Assessment. Compared to the rehabilitation-alone group, the rehabilitation + repetitive transcranial magnetic stimulation group demonstrated significant additional improvement on the Fugl-Meyer Assessment (p < 0.05), and the rehabilitation + repetitive transcranial magnetic stimulation + repetitive peripheral magnetic stimulation group demonstrated the most evident Fugl-Meyer Assessment improvement (p < 0.01). No significant difference in Fugl-Meyer Assessment improvement was observed between the rehabilitation + repetitive transcranial magnetic stimulation group and the rehabilitation + repetitive transcranial magnetic stimulation + repetitive peripheral magnetic stimulation group. These results indicate that the implementation of repetitive transcranial magnetic stimulation and repetitive peripheral magnetic stimulation can facilitate motor recovery in subacute stroke patients, and repetitive peripheral magnetic stimulation may be useful to enhance the effect of repetitive transcranial magnetic stimulation. The optimization of the best repetitive peripheral magnetic stimulation protocols is a future task.