Effects of repetitive transcranial magnetic stimulation on motor recovery and motor cortex excitability in patients with stroke: a randomized controlled trial

Background and purpose Repetitive transcranial magnetic stimulation ( rTMS ) changes the excitability of the motor cortex and thereby has the potential to enhance motor recovery after stroke. This randomized, sham‐controlled, double‐blind study was to compare the effects of high‐frequency versus low‐frequency rTMS on motor recovery during the early phase of stroke and to identify the neurophysiological correlates of motor improvements. Methods A total of 69 first‐ever ischemic stroke patients with motor deficits were randomly allocated to receive five daily sessions of 3‐Hz ipsilesional rTMS , 1‐Hz contralesional rTMS or sham rTMS in addition to standard physical therapy. Outcome measures included motor deficits, neurological scores and cortical excitability, which were assessed at baseline, after the intervention and at 3‐month follow‐up. Results The rTMS groups manifested greater motor improvements than the control group, which were sustained for at least 3 months after the end of the treatment sessions. 1‐Hz rTMS over the unaffected hemisphere produced more profound effects than 3‐Hz rTMS in facilitating upper limb motor performance. There was a significant correlation between motor function improvement and motor cortex excitability change in the affected hemisphere. Conclusions Repetitive transcranial magnetic stimulation is a beneficial neurorehabilitative strategy for enhancing motor recovery in the acute and subacute phase after stroke.