Repetitive Transcranial Magnetic Stimulation of the Unaffected Hemisphere in a Patient Who Was Forced to Use the Affected Hand

Takeuchi N, Toshima M, Chuma T, Matsuo Y, Ikoma K: Repetitive transcranial magnetic stimulation of the unaffected hemisphere in a patient who was forced to use the affected hand. Am J Phys Med Rehabil 2008;87:74–77. We present a case report of a 56-yr-old chronic stroke patient with right hemiparesis who was treated with repetitive transcranial magnetic stimulation (rTMS) therapy. Before stroke, the patient had suffered an accident that led to paralysis and contracture of the left upper limb, and, subsequently, he was forced to use only his right upper limb for routine activities, despite right hemiparesis. We performed subthreshold rTMS (1 Hz, 25 mins) and sham stimulation of the contralesional primary motor cortex (M1) at different times. Immediately after rTMS, the patient was able to write characters with increased speed and accuracy, and this effect continued for more than 7 days; however, this was not the case after sham stimulation. Moreover, the writing practice after rTMS improved the patient’s pinch force.