Priming with 1-Hz Repetitive Transcranial Magnetic Stimulation over Contralesional Leg Motor Cortex Does Not Increase the Rate of Regaining Ambulation Within 3 Months of Stroke: A Randomized Controlled Trial

Abstract The potential benefits of repetitive transcranial magnetic stimulation (rTMS), applied either alone or as a combination treatment, on recovery of lower extremities after stroke have been insufficiently studied. To evaluate the effect of priming with 1-Hz rTMS over contralesional leg motor area with a double cone coil prior physical therapy (PT) on regaining ambulation. Thirty-eight subacute stroke patients with significant leg disabilities were randomly assigned into the experimental (E) group or control (C) group to receive a 15-min real or sham 1-Hz rTMS, respectively, over the contralesional motor cortex representing the quadriceps muscle followed by 45-min PT for 15 sessions over 3 weeks. Functional measures, motor evoked potentials and quality of life were assessed. There was no significant difference between Group E and C regarding the recovery in ambulation, balance, motor functions, and activity of daily living. No significant difference was found in other functional measures and the quality of life. Only group C displayed significantly increased cortical excitability of the contralesional hemisphere after the intervention. The present study found insufficient evidence that contralesional priming with 1-Hz rTMS improves ambulatory and other motor functions among patients with a severe leg dysfunction in subacute stroke.