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(Stroke. 2009;40:309.)
© 2009 American Heart Association, Inc.

Research Letters

Safety and Behavioral Effects of High-Frequency Repetitive Transcranial Magnetic Stimulation in Stroke

Nuray Yozbatiran, PhD; Miguel Alonso-Alonso, MD; Jill See, PT, MPT; Asli Demirtas-Tatlidede, MD; Daniel Luu, BS; Rehan R. Motiwala, BS; Alvaro Pascual-Leone, MD, PhD Steven C. Cramer, MD

From the Departments of Neurology and Anatomy & Neurobiology (N.Y., J.S., D.L., R.R.M., S.C.C.), University of California, Irvine, Irvine, Calif; and the Berenson-Allen Center for Noninvasive Brain Stimulation (M.A.-A., A.D.-T., A.P.-L.), Beth Israel-Deaconess Medical Center and Harvard Medical School, Boston, Mass.

Correspondence to Steven C. Cramer, MD, University of California, Irvine Medical Center, 101 The City Drive South, Building 53, Room 203, Orange, CA 92868-4280. E-mail scramer{at}uci.edu

Background and Purpose— Electromagnetic brain stimulation might have value to reduce motor deficits after stroke. Safety and behavioral effects of higher frequencies of repetitive transcranial magnetic stimulation (rTMS) require detailed assessment.

Methods— Using an active treatment-only, unblinded, 2-center study design, patients with chronic stroke received 20 minutes of 20 Hz rTMS to the ipsilesional primary motor cortex hand area. Patients were assessed before, during the hour after, and 1 week after rTMS.

Results— The 12 patients were 4.7±4.9 years poststroke (mean±SD) with moderate–severe arm motor deficits. In terms of safety, rTMS was well tolerated and did not cause new symptoms; systolic blood pressure increased from pre- to immediately post-rTMS by 7 mm Hg (P=0.043); and none of the behavioral measures showed a decrement. In terms of behavioral effects, modest improvements were seen, for example, in grip strength, range of motion, and pegboard performance, up to 1 week after rTMS. The strongest predictor of these motor gains was lower patient age.

Conclusions— A single session of high-frequency rTMS to the motor cortex was safe. These results require verification with addition of a placebo group and thus blinded assessments across a wide spectrum of poststroke deficits and with larger doses of 20 Hz rTMS.

Key Words: plasticity • recovery • stroke • transcranial magnetic stimulation • treatment

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