Abstract TMP41: Sensory Function Improvement After 5Hz Contralesional rTMS in Chronic Stroke


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Abstract

Purpose: Sensory deficits are prevalent after stroke but effective interventions are limited. Non-invasive brain stimulation is a promising adjunct to peripherally administered rehabilitation therapies. However, the utility of brain stimulation in sensory re-education after stroke has not been tested. The purpose of this study was to assess immediate response to repetitive Transcranial Magnetic Stimulation (rTMS) of the contralesional primary sensory cortex (S1).Methods: Stroke survivors (>6 mo post; n=16) with arm sensory deficits participated in 3 different rTMS treatments targeting contralesional S1 as follows: 1) Sham, 2) 5 Hz and 3) 1 Hz. rTMS was paired with peripherally directed modalities (electrical stimulation via mesh glove followed by hand vibration). rTMS paradigms were administered in random order 1 week apart. Outcomes included 2-point discrimination, vibration, monofilament discrimination and proprioception. Measures were collected before and 1 hour after treatment and responses were calculated as post minus pre for each session. Data did not appear to be normally distributed, nor were responses correlated between the 3 treatments. Kruskal-Wallis tests were employed.Results: Subjects were 59.8±8.3 years old, 43±38 months after stroke, 88% were male and 59% had subcortical stroke. Baseline sensory impairment for the stroke Affected (A) and Unaffected (U) arms were as follows: 2-point discrimination threshold 12.47±4.73mm (A) and 2.86±1.01mm (U), monofilament 4.98±1.69mm (A) and 3.55±0.55mm (U), proprioception % accuracy at index 71.67±24.6%(A) and 99.37±1.81% (U), vibration amplitude threshold in relative units 9.7±8.6(A) and 4.75±1.8(U). There was an improvement in 2-point discrimination after 5 Hz rTMS in the affected arm; a reduced threshold of 1.68±3.5mm following 5Hz intervention vs reduction of 0.333±1.18mm after 1 Hz and increase of 0.13±2.06mm after sham (p=0.009). The unaffected arm also had improvement in 2-point discrimination of 0.38±0.8mm following 5Hz rTMS compared with increased threshold after both 1Hz (0.6±0.73mm) and sham (0.2±0.77mm) (p=0.009).Conclusion: High frequency rTMS targeting contralesional S1 cortex is a potential adjunct intervention for sensory re-education after stroke.

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