Transcranial magnetic brain stimulation in post-stroke motor recovery

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation method that can modulate excitability of the human cortex. It has been assumed by different research groups that suppressing the undamaged contralesional motor cortex by repetitive low-frequency rTMS or increasing the excitability of the damaged hemisphere cortex by high-frequency rTMS will promote function recovery after stroke. Thus, repetitive TMS can be an adjuvant therapy for developed neurorehabilitation strategies for stroke patients. The purpose of this brief review was to provide an overview of the methods, physiologic basis and future views of the use of inhibitory and excitatory repetitive rTMS. Recent studies have reported that rTMS can effectively facilitate neural plasticity and induce motor recovery after stroke. The best rTMS pattern has not been established, a stronger evidence for the potential use of rTMS as clinical rehabilitative tool should be found. Conclusions: Cumulative rTMS has been shown to be important for continuous motor improvement in patients with stroke. The results of the studies indicate that neural plasticity is consolidated by rTMS intervention. Therefore, rTMS induces a more suitable environment for neural plasticity by artificially modulating the ipsilesional motor cortex, thus counteracting use-dependent plasticity impairment by facilitating plasticity in the affected hemisphere. Further well-designed studies in larger populations are required to determine whether rTMS in stroke can improve motor function and to identify the most effective rTMS protocols for stroke treatment.