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Safety of 6-Hz Primed Low-Frequency rTMS in Stroke

Program in Physical Therapy, University of Minnesota, Minneapolis, carey007{at}umn.edu

Chad D. Evans, MD

Department of Neurology, University of Minnesota, Minneapolis

David C. Anderson, MD

Department of Neurology, University of Minnesota, Minneapolis

Ela Bhatt

Program in Physical Therapy, University of Minnesota, Minneapolis

Ashima Nagpal

Program in Physical Therapy, University of Minnesota, Minneapolis

Teresa J. Kimberley, PhD, PT

Program in Physical Therapy, University of Minnesota, Minneapolis

Alvaro Pascual-Leone, PhD, MD

Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Background. Suppression of activity in the contralesional motor cortex may promote recovery of function after stroke. Furthermore, the known depressant effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) can be increased and prolonged by preceding it with 6-Hz priming stimulation. Objective. The authors explored the safety of 6-Hz primed low-frequency rTMS in 10 patients with ischemic stroke. Methods. Priming consisted of 10 minutes of 6-Hz rTMS applied to the contralesional hemisphere at 90% of resting motor threshold delivered in 2 trains/min with 5 s/train and 25-second intervals between trains. Low-frequency rTMS consisted of an additional 10 minutes of 1-Hz rTMS at 90% of resting motor threshold without interruption. Possible adverse effects were assessed with the National Institutes of Health Stroke Scale (NIHSS), the Wechsler Adult Intelligence Scale—Third Edition (WAIS-III), the Hopkins Verbal Learning Test—Revised (HVLT-R), the Beck Depression Inventory—Second Edition (BDI-II), a finger movement tracking test, and individual self-assessments. Pretest, treatment, and posttest occurred on the first day with follow-up tests on the next 5 weekdays. Results. There were no seizures and no impairment of NIHSS, WAIS-III, or BDI-II scores. Transient impairment occurred on the HVLT-R. Transient tiredness was common. Occasional reports of headache, neck pain, increased sleep, reduced sleep, nausea, and anxiety occurred. Conclusion. Because there were no major adverse effects, the authors concluded that the treatment was safe for the individuals in this study and that further investigation is now warranted to examine efficacy and safety of serial treatments of 6-Hz primed low-frequency rTMS.

Key Words: Stroke • Seizure • rTMS • Safety • Recovery • Primary motor area.

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