Abstract BACKGROUND AND PURPOSE: The purpose of this study was to compare the long-term effect of five daily sessions of 1 vs. 3 Hz repetitive transcranial magnetic stimulation (rTMS) on motor recovery in acute stroke. METHODS: A total of 36 patients with acute ischaemic stroke participated in the study. The patients were randomly assigned into one of three groups; the first and second groups received real rTMS; 1 and 3 Hz and third group received sham stimulation, daily for 5 days. Motor disability was assessed before and after the last session, and then after first, second and third month. Cortical excitability was assessed before and after the second and fifth session. The outcome measure was clinical disability at 3 months post-rTMS. RESULTS: No significant differences were found in basal rating scales between the three groups. At the 3-month time point, both of the real rTMS groups had improved significantly more in different rating scales than the sham group; in addition, the 1 Hz group performed better than the 3 Hz group. Measures of cortical excitability immediately after the last session showed that the 1 Hz group had reduced excitability of the non-stroke hemisphere and increased excitability of the stroke hemisphere, whereas the 3 Hz group only showed increased excitability of the stroke hemisphere. CONCLUSION: These results confirm that five daily sessions of rTMS over motor cortex using either 1 Hz over the unaffected hemisphere or 3 Hz over the affected hemisphere can enhance recovery. At 3 months, the improvement was more pronounced in 1 Hz group.

Abstract BACKGROUND: There is some evidence for a therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) on dysphagia in hemispheric stroke. AIM: To compare the effect of active or sham rTMS applied to the motor area of both hemispheres in patients with acute lateral medullary infarction (LMI) or other brainstem infarctions. MATERIAL AND METHOD: The study included 22 patients with acute ischaemic stroke who had severe bulbar manifestation. 11 patients had LMI, and 11 had another brainstem infarction. They were randomly allocated to receive active (n=11) or sham (n=11) rTMS of the oesophageal motor cortex. Each patient received 300 rTMS pulses at 3 Hz and an intensity of 130% resting motor threshold to each hemisphere for five consecutive days. Clinical ratings of dysphagia and motor disability were assessed before and immediately after the last session, and then again after 1 and 2 months. RESULTS: There were no significant differences in baseline clinical assessment of swallowing between active and sham groups. Active rTMS improved dysphagia compared with sham rTMS in both groups of patients, (p=0.001 for both); the LMI group also improved the scores in the Barthel Index. All improvements were maintained over 2 months of follow-up (p=0.001). CONCLUSION: These findings suggest that rTMS could be a useful adjuvant strategy in neurorehabilitation of dysphagia due to LMI or other brainstem infarction, although further assessment is necessary in multicentre clinical trials.

Abstract BACKGROUND: There is some evidence for a therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) on dysphagia in hemispheric stroke. AIM: To compare the effect of active or sham rTMS applied to the motor area of both hemispheres in patients with acute lateral medullary infarction (LMI) or other brainstem infarctions. MATERIAL AND METHOD: The study included 22 patients with acute ischaemic stroke who had severe bulbar manifestation. 11 patients had LMI, and 11 had another brainstem infarction. They were randomly allocated to receive active (n=11) or sham (n=11) rTMS of the oesophageal motor cortex. Each patient received 300 rTMS pulses at 3 Hz and an intensity of 130% resting motor threshold to each hemisphere for five consecutive days. Clinical ratings of dysphagia and motor disability were assessed before and immediately after the last session, and then again after 1 and 2 months. RESULTS: There were no significant differences in baseline clinical assessment of swallowing between active and sham groups. Active rTMS improved dysphagia compared with sham rTMS in both groups of patients, (p=0.001 for both); the LMI group also improved the scores in the Barthel Index. All improvements were maintained over 2 months of follow-up (p=0.001). CONCLUSION: These findings suggest that rTMS could be a useful adjuvant strategy in neurorehabilitation of dysphagia due to LMI or other brainstem infarction, although further assessment is necessary in multicentre clinical trials.

Abstract This review discusses the clinical results that were obtained by applying rTMS in acute and chronic ischemic stroke patients. These studies included only the recovery of motor disability and dysphagia. In summary, two approaches have been used when employing rTMS as a potential therapy for the treatment of stroke. The most direct approach involves applying rTMS directly over the affected hemisphere in an attempt to increase excitability and plasticity of damaged circuits to improve motor function. The second approach has taken advantage of the concept of interhemispheric balance in which damage to the stroke hemisphere is exacerbated by increased inhibition from the intact non-stroke hemisphere. In this case, inhibitory rTMS is applied to the non-stroke hemisphere with the intention of reducing interhemispheric inhibition and restoring the balance of excitation between the motor cortices.The overall procedure remains to be optimized, in particular regarding the number of rTMS sessions, frequency and intensity of stimulation and the exact timing of rTMS application after stroke. Cortical stimulation is an effective method for improving functional recovery of acute and chronic stroke.

Abstract This review discusses the clinical results that were obtained by applying rTMS in acute and chronic ischemic stroke patients. These studies included only the recovery of motor disability and dysphagia. In summary, two approaches have been used when employing rTMS as a potential therapy for the treatment of stroke. The most direct approach involves applying rTMS directly over the affected hemisphere in an attempt to increase excitability and plasticity of damaged circuits to improve motor function. The second approach has taken advantage of the concept of interhemispheric balance in which damage to the stroke hemisphere is exacerbated by increased inhibition from the intact non-stroke hemisphere. In this case, inhibitory rTMS is applied to the non-stroke hemisphere with the intention of reducing interhemispheric inhibition and restoring the balance of excitation between the motor cortices.The overall procedure remains to be optimized, in particular regarding the number of rTMS sessions, frequency and intensity of stimulation and the exact timing of rTMS application after stroke. Cortical stimulation is an effective method for improving functional recovery of acute and chronic stroke.

Abstract OBJECTIVE: The primary purpose of this study was to provide insight into the central changes that occur in amyotrophic lateral sclerosis (ALS) with a view to understanding how these could contribute to symptoms. MATERIAL AND METHODS: Seventeen patients with definite ALS and 17 control healthy volunteers were included in the study. Clinical examination, amyotrophic lateral sclerosis severity score (ALSSS) and TMS investigations including measurement of resting and active motor threshold (RMT and AMT), motor evoked potential (MEP), input-output curve, contralateral silent period, and transcallosal inhibition (CSP and TI, postulated markers of GABAb function) were measured for each participant. RESULTS: There were no significant differences in RMT or AMT in either hemisphere between patients and the control group. Despite this there was a significant negative correlation between ALSSS and RMT and AMT meaning that increased severity was associated with higher thresholds. MEPs were significantly smaller in ALS patients in comparison to the control group (P = 0.03). There was a significant decrease in the slope of the I/O relationship of MEP amplitude to TMS intensity in patients group in comparison to controls. ALS patients had a significant prolongation of CSP and TI for both hemispheres. There was a tendency for a significant negative correlation between left TI and ALSSS (P = 0.051). CONCLUSION: Measurements of cortical motor excitatory changes in ALS confirm the presence of corticospinal hypoexcitability. Additionally we found increased excitability of presumed intracortical GABAb circuits that correlated with the severity of ALS. We postulate that the disease results in an imbalance between excitation and inhibition in the cortex that can contribute to clinical symptoms.

Abstract OBJECTIVE: The primary purpose of this study was to provide insight into the central changes that occur in amyotrophic lateral sclerosis (ALS) with a view to understanding how these could contribute to symptoms. MATERIAL AND METHODS: Seventeen patients with definite ALS and 17 control healthy volunteers were included in the study. Clinical examination, amyotrophic lateral sclerosis severity score (ALSSS) and TMS investigations including measurement of resting and active motor threshold (RMT and AMT), motor evoked potential (MEP), input-output curve, contralateral silent period, and transcallosal inhibition (CSP and TI, postulated markers of GABAb function) were measured for each participant. RESULTS: There were no significant differences in RMT or AMT in either hemisphere between patients and the control group. Despite this there was a significant negative correlation between ALSSS and RMT and AMT meaning that increased severity was associated with higher thresholds. MEPs were significantly smaller in ALS patients in comparison to the control group (P = 0.03). There was a significant decrease in the slope of the I/O relationship of MEP amplitude to TMS intensity in patients group in comparison to controls. ALS patients had a significant prolongation of CSP and TI for both hemispheres. There was a tendency for a significant negative correlation between left TI and ALSSS (P = 0.051). CONCLUSION: Measurements of cortical motor excitatory changes in ALS confirm the presence of corticospinal hypoexcitability. Additionally we found increased excitability of presumed intracortical GABAb circuits that correlated with the severity of ALS. We postulate that the disease results in an imbalance between excitation and inhibition in the cortex that can contribute to clinical symptoms.

Abstract OBJECTIVE: The primary purpose of this study was to provide insight into the central changes that occur in amyotrophic lateral sclerosis (ALS) with a view to understanding how these could contribute to symptoms. MATERIAL AND METHODS: Seventeen patients with definite ALS and 17 control healthy volunteers were included in the study. Clinical examination, amyotrophic lateral sclerosis severity score (ALSSS) and TMS investigations including measurement of resting and active motor threshold (RMT and AMT), motor evoked potential (MEP), input-output curve, contralateral silent period, and transcallosal inhibition (CSP and TI, postulated markers of GABAb function) were measured for each participant. RESULTS: There were no significant differences in RMT or AMT in either hemisphere between patients and the control group. Despite this there was a significant negative correlation between ALSSS and RMT and AMT meaning that increased severity was associated with higher thresholds. MEPs were significantly smaller in ALS patients in comparison to the control group (P = 0.03). There was a significant decrease in the slope of the I/O relationship of MEP amplitude to TMS intensity in patients group in comparison to controls. ALS patients had a significant prolongation of CSP and TI for both hemispheres. There was a tendency for a significant negative correlation between left TI and ALSSS (P = 0.051). CONCLUSION: Measurements of cortical motor excitatory changes in ALS confirm the presence of corticospinal hypoexcitability. Additionally we found increased excitability of presumed intracortical GABAb circuits that correlated with the severity of ALS. We postulate that the disease results in an imbalance between excitation and inhibition in the cortex that can contribute to clinical symptoms.

Abstract OBJECTIVE: The primary purpose of this study was to provide insight into the central changes that occur in amyotrophic lateral sclerosis (ALS) with a view to understanding how these could contribute to symptoms. MATERIAL AND METHODS: Seventeen patients with definite ALS and 17 control healthy volunteers were included in the study. Clinical examination, amyotrophic lateral sclerosis severity score (ALSSS) and TMS investigations including measurement of resting and active motor threshold (RMT and AMT), motor evoked potential (MEP), input-output curve, contralateral silent period, and transcallosal inhibition (CSP and TI, postulated markers of GABAb function) were measured for each participant. RESULTS: There were no significant differences in RMT or AMT in either hemisphere between patients and the control group. Despite this there was a significant negative correlation between ALSSS and RMT and AMT meaning that increased severity was associated with higher thresholds. MEPs were significantly smaller in ALS patients in comparison to the control group (P = 0.03). There was a significant decrease in the slope of the I/O relationship of MEP amplitude to TMS intensity in patients group in comparison to controls. ALS patients had a significant prolongation of CSP and TI for both hemispheres. There was a tendency for a significant negative correlation between left TI and ALSSS (P = 0.051). CONCLUSION: Measurements of cortical motor excitatory changes in ALS confirm the presence of corticospinal hypoexcitability. Additionally we found increased excitability of presumed intracortical GABAb circuits that correlated with the severity of ALS. We postulate that the disease results in an imbalance between excitation and inhibition in the cortex that can contribute to clinical symptoms.

Abstract INTRODUCTION: In Alzheimer's disease (AD), transcranial magnetic stimulation (TMS) studies have been limited to test motor cortical excitability. The aim of this study was to investigate the inhibitory circuits of the motor cortex and to relate these to measures of cognitive function in AD patients. Results were compared with those of a control group of healthy subjects matched for age, sex and education. PATIENTS AND METHODS: Forty-five AD patients and 37 healthy volunteers were included in the study. Each participant received a neurological evaluation, Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR). Neurophysiological evaluations included resting and active motor threshold (rMT and aMT), motor evoked potential (MEP), cortical silent period (CSP), and transcallosal inhibition (TI). RESULTS: AD patients showed significantly reduced rMT, aMT and shorter MEP onset latency; in addition there was a prolongation of both CSP and TI. There was a significant positive correlation between the MMSE and CDR, on the one hand, and aMT and rMT, on the other hand, whereas the correlation was negative with CSP and TI durations. CONCLUSION: AD is associated with hyperexcitability of the motor cortex, which supports the hypothesis that changes in GABAb and glutamate function are important factors in cognitive impairment.