| 제목 |
Therapeutic effect of rTMS in patients without MEP in acute stage after stroke |
| 소속 |
Seoul National University Hospital , Department of Rehabilitation Medicine 1, Seoul National University Boramae Medical Center, Department of Rehabilitation Medicine2 |
| 저자 |
Seung Yeun Kim1*, Se Hee Jung2† |
Background :
Repetitive transcranial magnetic stimulation (rTMS) is expected to modulate the corticospinal excitability and the effects appear to last beyond the duration of rTMS itself. However, conventionally, rTMS is considered only effective on patients whose motor evoked potential (MEP) are present and there has been no study which compared the effect of rTMS on post-stroke motor recovery between MEP-present and MEP-negative patients in the acute phase. Here, we aimed to investigate whether rTMS is also effective on MEP-negative patients.
Methods :
We reviewed the medical records of patients who underwent MEP study within 1 month from 2010 to 2015. We selected patients who underwent 1Hz rTMS on the primary motor cortex for the unaffected hand for 10 days within 6 months after stroke. Patients whose MEP was absent in the affected upper extremity were enrolled as MEP (-) group and patients whose MEP was present were enrolled as MEP (+) group. The recovery of upper extremity motor function was assessed by Fugl-Meyer scale (FMS) and hand power measurement at baseline, 3 and 6 months after stroke. Functional recovery was assessed by the modified Barthel index related to the upper extremity (MBI_UE) at the same time.
Results :
Total 21 stroke patients (62.86±14.25 years; 13 men; 10 in MEP (-) group) were enrolled. Time from the onset of stroke to rTMS was 20.50±4.80 days in MEP (+) group and 21.70±5.10 days in MEP (-) group. There was no significant difference between MEP (+) and MEP (-) group in sex (p=0.477) and the affected hemisphere (p=0.605). However, age was significantly different between groups (71.36±8.82 years in MEP (+) and 53.50±13.37 years in MEP (-) group, p=0.02). Although MEP (+) group showed significant motor recovery (p=0.028 in FMS and p=0.018 in hand power) at post-stroke 6 months, there was no significant improvement in FMS (p=0.123) and hand power (p=0.068) at post-stroke 6 months in MEP (-) group. Both groups showed significant improvement in MBI_UE at post-stroke 6 months. (p=0.003 in MEP (+) group and p=0.016 in MEP (-) group).
Conclusion :
The present study shows that there is no significant treatment effect of rTMS on post-stroke motor recovery of patients whose MEP was absent in acute phase. MEP response in acute phase should be considered in clinical decision regarding application of rTMS for motor recovery. |
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