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(Stroke. 2006;37:1471.)
© 2006 American Heart Association, Inc.

Original Contributions

Repetitive Transcranial Magnetic Stimulation–Induced Corticomotor Excitability and Associated Motor Skill Acquisition in Chronic Stroke

Yun-Hee Kim, MD, PhD; Sung H. You, PT, PhD; Myoung-Hwan Ko, MD, PhD; Ji-Won Park, PhD; Kwang Ho Lee, MD, PhD; Sung Ho Jang, MD; Woo-Kyoung Yoo, MD Mark Hallett, MD

From the Department of Physical Medicine and Rehabilitation, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.H.K.); Hampton University, Doctor of Physical Therapy Program, Hampton, Va (S.H.Y.); Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea (M.H.K.); Department of Physical Therapy, College of Health Science, Catholic University of Daegu, Daegu, Republic of Korea (J.W.P.); Department of Neurology, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.H.L.); Department of Physical Medicine and Rehabilitation, School of Medicine, Yeungnam University, Daegu, Republic of Korea (S.H.J.); Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Dongan-ku, Anyang, Republic of Korea (W.K.Y.); and National Institute of Neurological Disorders and Stroke, Human Motor Control Section, National Institutes of Health, Medical Neurology Branch, Bethesda, Md (M.H.).

Reprint requests to Yun-Hee Kim, Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Republic of Korea. E-mail: yunkim{at}smc.samsung.co.kr

Background and Purpose— Although there is some early evidence showing the value of repetitive transcranial magnetic stimulation (rTMS) in stroke rehabilitation, the therapeutic effect of high-frequency rTMS, along with the physiology of rTMS-induced corticomotor excitability supporting motor learning in stroke, has not been established. This study investigated high-frequency rTMS-induced cortical excitability and the associated motor skill acquisition in chronic stroke patients.

Methods— Fifteen patients with chronic hemiparetic stroke (13 men; mean age 53.5 years) practiced a complex, sequential finger motor task using their paretic fingers either after 10 Hz or sham rTMS over the contralateral primary motor cortex (M1). Both the changes in the behavior and corticomotor excitability before and after the intervention were examined by measuring the movement accuracy, the movement time, and the motor-evoked potential (MEP) amplitude. A separate repeated-measures ANOVA and correlation statistics were used to determine the main and interaction effects as well as relationship between the changes in the behavioral and corticomotor excitability.

Results— High-frequency rTMS resulted in a significantly larger increase in the MEP amplitude than the sham rTMS (P<0.01), and the plastic change was positively associated with an enhanced motor performance accuracy (P<0.05).

Conclusions— High-frequency rTMS of the affected motor cortex can facilitate practice-dependent plasticity and improve the motor learning performance in chronic stroke victims.

Key Words: motor activity • stroke • transcranial magnetic stimulation

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