Repetitive Transcranial Magnetic Stimulation–Induced Corticomotor Excitability and Associated Motor Skill Acquisition in Chronic Stroke

TLDR

Repetitive transcranial magnetic stimulation shows promise for stroke rehabilitation, but the therapeutic impact of high‑frequency rTMS and its role in corticomotor excitability for motor learning remain unconfirmed. The study examined whether high‑frequency rTMS enhances cortical excitability and motor skill learning in chronic stroke patients. Fifteen chronic hemiparetic stroke patients performed a sequential finger task after 10 Hz or sham rTMS over contralateral M1, with movement accuracy, time, and motor‑evoked potential amplitude measured pre‑ and post‑intervention and analyzed via repeated‑measures ANOVA and correlation statistics. High‑frequency rTMS produced a greater increase in MEP amplitude than sham (P < 0.01) and this plasticity correlated with improved motor accuracy (P < 0.05), indicating that high‑frequency rTMS facilitates practice‑dependent plasticity and motor learning in chronic stroke.

Abstract

Background and Purpose— Although there is some early evidence showing the value of repetitive transcranial magnetic stimulation (rTMS) in stroke rehabilitation, the therapeutic effect of high-frequency rTMS, along with the physiology of rTMS-induced corticomotor excitability supporting motor learning in stroke, has not been established. This study investigated high-frequency rTMS-induced cortical excitability and the associated motor skill acquisition in chronic stroke patients. Methods— Fifteen patients with chronic hemiparetic stroke (13 men; mean age 53.5 years) practiced a complex, sequential finger motor task using their paretic fingers either after 10 Hz or sham rTMS over the contralateral primary motor cortex (M1). Both the changes in the behavior and corticomotor excitability before and after the intervention were examined by measuring the movement accuracy, the movement time, and the motor-evoked potential (MEP) amplitude. A separate repeated-measures ANOVA and correlation statistics were used to determine the main and interaction effects as well as relationship between the changes in the behavioral and corticomotor excitability. Results— High-frequency rTMS resulted in a significantly larger increase in the MEP amplitude than the sham rTMS ( P &lt;0.01), and the plastic change was positively associated with an enhanced motor performance accuracy ( P &lt;0.05). Conclusions— High-frequency rTMS of the affected motor cortex can facilitate practice-dependent plasticity and improve the motor learning performance in chronic stroke victims.