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(Stroke. 2007;38:254.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Response to Letter by Hotermans et al

Yun-Hee Kim, MD, PhD

Department of Physical Medicine and Rehabilitation, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

Sung H. You, PT, PhD

Department of Physical Therapy, Graduate School of Rehabilitation Therapy, Yonsei University, Wonju City, Kangwon-do, Republic of Korea

Myoung-Hwan Ko, MD, PhD

Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea

Ji-Won Park, PhD

Department of Physical Therapy, Catholic University of Daegu, Daegu, Republic of Korea

Kwang Ho Lee, MD, PhD

Department of Neurology, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

Sung Ho Jang, MD

Department of Physical Medicine and Rehabilitation, School of Medicine, Yeungnam University, Taegu, Republic of Korea

Woo-Kyoung Yoo, MD

Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Pyoungchondong Dongan-ku, Anyang, Republic of Korea

Mark Hallett, MD

Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md

Response:

We thank Hotermans and colleagues for their insightful comments. In general, we concur with their comments. Despite robust and meticulous experimental procedure, clinical rTMS trials on both individuals with normal and/or pathological conditions show a large inter-/intrasubject variability in cortical excitability and associated motor behaviors. Such variability may result from issues related to subjects’ inherent brain morphology, lesion, precise stimulation site and parameters of stimulation including the frequency, intensity, intervals, number of repetitions, and duration.^1–3

As Dr Hotermans et al pointed out, the patient safety guideline for the use of high-frequency rTMS and intervention customization are important issues that need to be continuously addressed. Because we have strictly adhered to the established rTMS guideline⁴ and used robust inclusion criteria for safety reasons, no undesirable effect was seen in our patients during or after rTMS. Currently, a very large number of rTMS techniques and experimental paradigms have been implemented and are under investigation. It is only through scrupulous experimental studies, such as the one we have done, that we will be able to determine the best safe and effective intervention methods to help patients.

Acknowledgments

Disclosures

None.

References

1. Liepert J, Restemeyer C, Kucinski T, Zittel S, Weiller C. Motor strokes: the lesion location determines motor excitability changes. Stroke. 2005; 36: 2648–2653.[Abstract/Free Full Text]
2. Maeda F, Keenan JP, Tormos JM, Topka H, Pascual-Leone A. Modulation of corticospinal excitability by repetitive transcranial magnetic stimulation. Clin Neurophysiol. 2000; 111: 800–805.[CrossRef][Medline] [Order article via Infotrieve]
3. Gangitano M, Valero-Cabre A, Tormos JM, Mottaghy FM, Romero JR, Pascual-Leone A. Modulation of input-output curves by low and high frequency repetitive transcranial magnetic stimulation of the motor cortex. Clin Neurophysiol. 2002; 113: 1249–1257.[CrossRef][Medline] [Order article via Infotrieve]
4. Wassermann EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5–7, 1996. Electroencephalogr Clin Neurophysiol. 1998; 108: 1–16.[CrossRef][Medline] [Order article via Infotrieve]

This Article Full Text (PDF) All Versions of this Article: 38/2/254    most recent 01.STR.0000254534.50137.f6v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kim, Y.-H. Articles by Hallett, M. Search for Related Content PubMed PubMed Citation Articles by Kim, Y.-H. Articles by Hallett, M.