Effect of baseline brain activity on response to low-frequency rTMS/intensive occupational therapy in poststroke patients with upper limb hemiparesis: a near-infrared spectroscopy study.

Abstract

BACKGROUND:

The beneficial effects of the combination therapy of low-frequency repetitive transcranial magnetic stimulation of nonlesional hemisphere and intensive occupational therapy (LF-rTMS/OT) on upper limb hemiparesis have been well established in poststroke patients. However, there is no information on the effect of brain activity on LF-rTMS/OT treatment outcome.

METHOD:

A total of 59 poststroke patients with upper limb hemiparesis received 15-day LF-rTMS/OT. Motor function of the affected upper limb was evaluated before and after the treatment. We also conducted functional near-infrared spectroscopy (fNIRS) before the treatment and calculated the laterality index (LI) based on the change in oxy-hemoglobin in the primary sensorimotor cortex and supplementary motor cortex. The correlation between LI before LF-rTMS/OT and observed improvement in upper limb motor function was analyzed.

RESULTS:

Motor recovery was significantly more pronounced in patients with unaffected hemisphere dominance in both hemispheres (LI of -1 to 0) than in those with affected hemisphere dominance in the lesional hemisphere (LI of 0 to 1). There was a significant negative correlation between LI and improvement in upper limb motor function.

DISCUSSION:

The results demonstrated that patients with a shift in brain activity to the noninjured cerebral cortex exhibited better motor recovery following LF-rTMS/OT. The findings suggest that evaluation of brain asymmetry before LF-rTMS/OT with fNIRS can help predict the response to LF-rTMS/OT.

• Authors: Hiroaki Tamashiro, Shoji Kinoshita, Takatsugu Okamoto, Naoki Urushidani, Masahiro Abo
• Journal: The International journal of neuroscience (Int J Neurosci) Vol. 129 Issue 4 Pg. 337-343 (Apr 2019) ISSN: 1563-5279 [Electronic] England
• PMID: 30311827 (Publication Type: Journal Article)

Topics

• Aged
• Combined Modality Therapy
• Female
• Functional Laterality (physiology)
• Humans
• Male
• Middle Aged
• Motor Cortex (diagnostic imaging, physiopathology)
• Occupational Therapy (methods)
• Outcome Assessment, Health Care
• Paresis (etiology, physiopathology, therapy)
• Sensorimotor Cortex (diagnostic imaging, physiopathology)
• Spectroscopy, Near-Infrared (methods)
• Stroke (complications, physiopathology, therapy)
• Stroke Rehabilitation (methods)
• Transcranial Magnetic Stimulation (methods)
• Upper Extremity (physiopathology)