Stroke

Neurosci Behav Physiol. 2010 Oct;40(8):920-5.

The potential of transcranial magnetotherapy in color and rhythm therapy in the rehabilitation of ischemic stroke.

Sholomov II, Cherevashchenko LA, Suprunov OV, Raigorodskii YM.

Saratov State Medical University, Saratov, Russia.

Abstract

A total of 116 patients with ischemic stroke were studied during the early recovery period. The patients were divided into four groups – three experimental groups and one control group. Of these, 87 patients in the first three groups received transcranial magneto- and/or color and rhythm therapy (TcMT, CRT) along with traditional treatment, while the 29 patients of the control group received basal treatment only. TcMT was performed using a bitemporal method, with a running field regime with a modulation frequency of 1-10 Hz. CRT consisted of an alternating scheme of stimulation of the left and right eyes with green and/or blue light with a period of 2-4 sec and an on time of 1 sec. Each of the three experimental groups (group 1 received TcMT, group 2 received CRT, and group 3 received TcMT + CRT) received two courses of treatment separated by 1.5 months. After treatment, all experimental groups, particularly group 3, showed more marked improvements than the control group. Regression of neurological symptomatology on the Lindmark scale in group 3 was 9.5% greater than that in controls; improvements in impairments to activity and self-care ability on the Barthel scale were greater by 8.8%; memory and intellectual changes were also seen on the MMSE and the Luriya and Schulte tests. Rheography and electroencephalography demonstrated significant improvements in hemodynamics and alpha-rhythm differentiation and a 14.6% reduction in the proportion of patients with dysrhythmia in group 3 compared with the control group. The best result on all measures were obtained in patients given the combination of TcMT and CRT; TcMT had the greater influence on hemodynamics, while CRT had the greater effect on psychoemotional status. Both treatments were well tolerated and produced no side effects.

Clin Neurophysiol. 2010 Mar;121(3):441-7. Epub 2010 Jan 13.

Reduced motor cortex plasticity following inhibitory rTMS in older adults.

Todd G, Kimber TE, Ridding MC, Semmler JG.

Discipline of Physiology, School of Molecular and Biomedical Science, The University of Adelaide, Adelaide, SA, Australia. gabrielle.todd@adelaide.edu.au

Abstract

OBJECTIVE: Ageing is accompanied by diminished practice-dependent plasticity. We investigated the effect of age on another plasticity inducing paradigm, repetitive transcranial magnetic stimulation (rTMS).

METHODS: Healthy young (n=15; 25+/-4 years) and old (n=15; 67+/-5 years) adults participated in two experiments. Motor evoked potentials (MEPs) were measured in the target muscle (first dorsal interosseus, FDI) and a remote muscle (abductor digiti minimi) during a set of single stimuli. Subjects then received real or sham inhibitory rTMS (intermittent subthreshold trains of 6Hz stimulation for 10min). MEPs were measured for 30min after rTMS.

RESULTS: In young adults, MEPs in the target FDI muscle were approximately 15% smaller in the real rTMS experiment than in the sham rTMS experiment (P<0.026). In old adults, FDI MEP size did not differ between experiments.

CONCLUSIONS: Advancing age is associated with reduced efficacy of inhibitory rTMS.

SIGNIFICANCE: This work has important implications for the potential therapeutic use of rTMS in stroke and neurological disease.

Zh Nevrol Psikhiatr Im S S Korsakova. 2009;109(7):23-8.

Possibilities of transcranial magnetic therapy and color and rhythm therapy in rehabilitation of ischemic stroke.

[Article in Russian]

Sholomov II, Cherevashchenko LA, Suprunov OV, Ra?gorondski? IuM.

Abstract

One hundred and sixteen post-stroke patients were studied in the early rehabilitation period. All patients were divided into 4 groups: 3 main and 1 control groups. Three main groups (87 patients) received transcranial magnetic therapy (TMT) and/or color and rhythm therapy (CRT) along with traditional treatment and the control group (29 patients) received only basic therapy. TMT was conducted using bitemporal technique, running regime with modulation frequency 1-10 Hz. In CRT, the alternating stimulation of the right and left eye with green and/or blue color with a period of 2-4 s and duration of luminescence 1s was applied. Each of 3 main groups received 2 treatment sessions with an interval of 1,5 month (1st – TMT, 2nd – CRT, 3rd – TMT + CRT). After the treatment, the marked positive changes were seen in all main groups, in particular in group 3. The improvement of neurologic symptoms on the B. Lindmark scale was higher by 9,5% in group 3 compared to the control one, on the Barthel index – by 8,8%, on MMSE and A. Luria and Schulte test – by 5,4 and 14,3%, respectively. Rheographic and encephalographic study revealed the significant improvement of hemodynamics and alpha-rhythm differentiation, decrease of patients with dysrhythmia by 14,6% in group 3 as compared to the control group. The best results were seen in the combination of TMT and CRT, TMT exerted a higher effect on the hemodynamics and CRT – on the psychoemotional state. Both therapies were well tolerated and had no side-effects.

Stroke. 2009 Jan;40(1):309-12. Epub 2008 Oct 9.

Safety and behavioral effects of high-frequency repetitive transcranial magnetic stimulation in stroke.

Yozbatiran N, Alonso-Alonso M, See J, Demirtas-Tatlidede A, Luu D, Motiwala RR, Pascual-Leone A, Cramer SC.

Abstract

BACKGROUND AND PURPOSE: Electromagnetic brain stimulation might have value to reduce motor deficits after stroke. Safety and behavioral effects of higher frequencies of repetitive transcranial magnetic stimulation (rTMS) require detailed assessment.

METHODS: Using an active treatment-only, unblinded, 2-center study design, patients with chronic stroke received 20 minutes of 20 Hz rTMS to the ipsilesional primary motor cortex hand area. Patients were assessed before, during the hour after, and 1 week after rTMS.

RESULTS: The 12 patients were 4.7+/-4.9 years poststroke (mean+/-SD) with moderate-severe arm motor deficits. In terms of safety, rTMS was well tolerated and did not cause new symptoms; systolic blood pressure increased from pre- to immediately post-rTMS by 7 mm Hg (P=0.043); and none of the behavioral measures showed a decrement. In terms of behavioral effects, modest improvements were seen, for example, in grip strength, range of motion, and pegboard performance, up to 1 week after rTMS. The strongest predictor of these motor gains was lower patient age.

CONCLUSIONS: A single session of high-frequency rTMS to the motor cortex was safe. These results require verification with addition of a placebo group and thus blinded assessments across a wide spectrum of poststroke deficits and with larger doses of 20 Hz rTMS.

Lancet Neurol. 2008 Jun;7(6):507-13. Epub 2008 May 1.

Contralesional repetitive transcranial magnetic stimulation for chronic hemiparesis in subcortical paediatric stroke: a randomised trial.

Kirton A, Chen R, Friefeld S, Gunraj C, Pontigon AM, Deveber G.

Division of Neurology, Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, Canada. adam.kirton@calgaryhealthregion.ca

Abstract

BACKGROUND: Arterial ischaemic stroke (AIS) can cause disabling hemiparesis in children. We aimed to test whether contralesional, inhibitory repetitive transcranial magnetic stimulation (rTMS) could affect interhemispheric inhibition to improve hand function in chronic subcortical paediatric AIS.

METHODS: Patients were eligible for this parallel, randomised trial if they were in the SickKids Children’s Stroke Program and had subcortical AIS more than 2 years previously, had transcallosal sparing, were more than 7 years of age, had hand motor impairment, had no seizures or dyskinesia, and were taking no drugs that alter cortical excitability. Patients were paired for age and weakness and were randomised within each pair to sham treatment or inhibitory, low-frequency rTMS over contralesional motor cortex (20 min, 1200 stimuli) once per day for 8 days. An occupational therapist did standardised tests of hand function at days 1 (baseline), 5, 10, and 17 (1 week post-treatment), and the primary outcomes were changes in grip strength and the Melbourne assessment of upper extremity function (MAUEF) between baseline and day 10. Patients, parents, and occupational therapists were blinded to treatment allocation. Analysis was per protocol.

FINDINGS: Ten patients with paediatric stroke were enrolled (median age 13.25 [IQR 10.08-16.78] years, mean time post-stroke 6.33 [SD 3.56] years): four with mild weakness, two with moderate weakness, and four with severe weakness. A repeated-measures ANOVA showed a significant interaction between time and the effect of treatment on grip strength (p=0.03). At day 10, grip strength was 2.28 (SD 1.01) kg greater than baseline in the rTMS group and 2.92 (1.20) kg less than baseline in the sham group (p=0.009). Benefits in mean grip strength persisted at day 17 (2.63 [0.56] kg greater than baseline with rTMS and 1.00 [0.70] kg less than baseline with sham treatment; p=0.01). Day 10 MAUEF score improved by more in the rTMS group than in the sham group (7.25 [3.8] vs 0.79 [1.3] points greater than baseline; p=0.002), but this benefit did not persist to day 17. Function of the unaffected hand remained stable. rTMS was well tolerated with no serious adverse events.

INTERPRETATION: Contralesional inhibitory rTMS was safe and feasible for patients with paediatric subcortical AIS, and seemed to improve hand function in patients with hemiparesis. Further studies are required to confirm the potential role of rTMS in paediatric neurorehabilitation.

FUNDING: Canadian Stroke Consortium; Canadian Institutes of Health Research; American Academy of Neurology Foundation; Alberta Heritage Foundation for Medical Research.

Arch Neurol. 2008 Jun;65(6):741-7.

Effects of low-frequency repetitive transcranial magnetic stimulation of the contralesional primary motor cortex on movement kinematics and neural activity in subcortical stroke.

Nowak DA, Grefkes C, Dafotakis M, Eickhoff S, Küst J, Karbe H, Fink GR.

Department of Neurology, University Hospital Cologne, University of Cologne, Kerpener Strasse 62, D-50924 Cologne, Germany. dennis.nowak@uk-koeln.de

Abstract

BACKGROUND: Following the concept of interhemispheric competition, downregulation of the contralesional primary motor cortex (M1) may improve the dexterity of the affected hand after stroke.

OBJECTIVE: To determine the effects of 1-Hz repetitive transcranial magnetic stimulation (rTMS) of the contralesional M1 on movement kinematics and neural activation within the motor system in the subacute phase after subcortical stroke.

DESIGN: Crossover investigation.

SETTING: A university hospital.

METHODS: Fifteen right-handed patients with impaired dexterity due to subcortical middle cerebral artery stroke received 1-Hz rTMS for 10 minutes applied to the vertex (control stimulation) and contralesional M1. For behavioral testing, patients performed finger and grasp movements with both hands at 2 baseline conditions, separated by 1 week, and following each rTMS application. For functional magnetic resonance imaging, patients performed hand grip movements with their affected or unaffected hand before and after each rTMS application.

RESULTS: Application of rTMS to the contralesional M1 improved the kinematics of finger and grasp movements in the affected hand. At the neural level, rTMS applied to the contralesional M1 reduced overactivity in the contralesional primary and nonprimary motor areas. There was no significant correlation between the rTMS-induced reduction in blood oxygen level-dependent responses within the contralesional M1 and the degree of behavioral improvement of the affected hand. Overactivity of the contralesional dorsal premotor cortex, contralesional parietal operculum, and ipsilesional mesial frontal cortex at baseline predicted improvement of movement kinematics with the affected hand after rTMS of the contralesional M1.

CONCLUSION: The functional magnetic resonance imaging data suggest that rTMS of the contralesional M1 may normalize neural activation within the cortical motor network after subcortical stroke. Identifying patients suitable for rTMS intervention based on individual patterns of cortical activation may help to implement rTMS in motor rehabilitation after stroke.

Przegl Lek. 2007;64(2):74-7.

Effect of low frequency magnetic fields used in magnetotherapy and magnetostimulation on the rehabilitation results of patients after ischemic stroke.

[Article in Polish]

Wolda?ska-Oko?ska M, Czernicki J.

Z Katedry Rehabilitacji Akademii Swietokrzyskiej, filii w Piotrkowie Trybunalskim. marta.okonska@poczta.onet.pl

Abstract

New methods of rehabilitation should be introduced in order to reduce disability resulting from stroke. During the twelve months of follow-up, effect of low frequency magnetic field (If mf) on the course of patient rehabilitation following ischemic stroke was evaluated on in-patient (acute and subacute period of the stroke) and outpatient (chronic period) basis with the use of Mathew et al’s and Barthel’s scales. Lf mf (20 procedures of 20-min. duration) of magnetotherapy (I group–placebo, II–group 5.6 mT induction, 10 Hz frequency and sinusoidal shape, III group–2.8 mT induction, 10 Hz frequency and sinusoidal shape) and magnetostimulation (IV group–M1P1 program of Viofor JPS system, 16 min a day) was applied as early as in the subacute period of the stroke (1-8 weeks). The data obtained were presented in the form of percentage changes in the pain levels as well as in the form of the arithmetical mean and standard deviation (X +/- SD). The ANOVA test was used for a statistical evaluation of the data obtained in the tests. The results obtained indicate beneficial effects of If mf in the III and IV group of patients in the Barthel’s scale and Mathew scale, which were observed during the examination 12 months after the stroke. The recommended doses of If mf seem to be adequate to obtain therapeutic effects and may be used in the early period of rehabilitation. The neurological and functional improvement persisted for a long-period of the out-patient treatment, which was confirmed during the control examination 12 months after the ischemic stroke. As no adverse effects (which could be attributed to If mf), were observed, this method of physical therapy can be recognized as a safe one and worth making popular in clinical practice.

Restor Neurol Neurosci. 2007;25(5-6):461-5.

Improvement of dexterity by single session low-frequency repetitive transcranial magnetic stimulation over the contralesional motor cortex in acute stroke: a double-blind placebo-controlled crossover trial.

Liepert J, Zittel S, Weiller C.

Department of Neurology, University Hospital, Freiburg, Germany. j.liepert@kliniken-schmieder.de

Abstract

PURPOSE: Increasing evidence suggests that the contralesional motor cortex (M1) inhibits the ipsilesional M1 in stroke patients. This inhibition could impair motor function of the affected hand. We investigated if inhibitory 1~Hz repetitive transcranial magnetic stimulation (rTMS) over the contralesional M1 improved motor performance of the affected hand in acute stroke.

METHODS: A double-blind study of real versus placebo rTMS was conducted. Twelve patients early after subcortical stroke (mean: 7 days) received 1200 stimuli of real and placebo rTMS in a crossover design. The sequence of stimulations was counterbalanced across subjects. Stimulus intensity was subthreshold (90% of motor threshold at rest). Motor function was tested by grip strength recordings and Nine Hole Peg Test (NHPT) executions before and after each rTMS session.

RESULTS: Compared to sham stimulation, real rTMS improved NHPT results but not grip strength in the affected hand. No change of performance was observed for the unaffected hand. NHPT baseline repetitions in a subgroup of patients indicated stable motor performance prior to the rTMS sessions.

CONCLUSIONS: The study suggests that therapeutic rTMS applications over the contralesional hemisphere are feasible in acute stroke patients and can transiently improve dexterity of the affected hand. RTMS may become an additional tool for early neurorehabilitation.

Prog Brain Res. 2005;150:527-35.

Neural plasticity and recovery of function.

Ward NS.

Wellcome Department of Imaging Neuroscience, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3BG, UK.

Recovery of the function after stroke is a consequence of many factors including resolution of oedema and survival of the ischaemic penumbra. In addition there is a growing interest in the role of central nervous system (CNS) reorganization. Much of the evidence supporting this comes from animal models of focal brain injury, but non-invasive techniques such as functional magnetic resonance imaging, transcranial magnetic stimulation, electroencephalography and magnetoencephalography now allow the study of the working human brain. Using these techniques it is apparent that the motor system of the brain adapts to damage in a way that attempts to preserve motor function. This has been demonstrated after stroke, as part of the ageing process, and even after disruption of normal motor cortex with repetitive transcranial magnetic stimulation. The result of this reorganization is a new functional architecture, one which will vary from patient to patient depending on the anatomy of the damage, the biological age of the patient and lastly the chronicity of the lesion. The success of any given therapeutic intervention will depend on how well it interacts with this new functional architecture. Thus it is crucial that the study of novel therapeutic strategies for treating motor impairment after stroke take account of this. This review maps out the attempts to describe functionally relevant adaptive changes in the human brain following focal damage. A greater understanding of how these changes are related to the recovery process will allow not only the development of novel therapeutic techniques that are based on neurobiological principles and designed to minimize impairment in patients suffering from stroke, but also to target these therapies at the appropriate patients.

Neurology. 2005 Aug 9;65(3):466-8.

Therapeutic trial of repetitive transcranial magnetic stimulation after acute ischemic stroke.

Khedr EM, Ahmed MA, Fathy N, Rothwell JC.

Department of Neurology, Assiut University Hospital, Assiut, Egypt. emankhedr99@yahoo.com

Repetitive transcranial magnetic stimulation (rTMS) or sham stimulation was given over the motor cortex daily for 10 days to two randomly assigned groups of 26 patients with acute ischemic stroke. Patients otherwise continued their normal treatment. Disability scales measured before rTMS, at the end of the last rTMS session, and 10 days later showed that real rTMS improved patients’ scores more than sham.

Stroke. 2005 Oct 27; [Epub ahead of print]

Repetitive Transcranial Magnetic Stimulation of Contralesional Primary Motor Cortex Improves Hand Function After Stroke.

Takeuchi N, Chuma T, Matsuo Y, Watanabe I, Ikoma K.

From the Department of Rehabilitation Medicine, Hokkaido University Graduate School of Medicine, Sapporo 060-0814, Japan.

BACKGROUND AND PURPOSE: A recent report has demonstrated that the contralesional primary motor cortex (M1) inhibited the ipsilesional M1 via an abnormal transcallosal inhibition (TCI) in stroke patients. We studied whether a decreased excitability of the contralesional M1 induced by 1 Hz repetitive transcranial magnetic stimulation (rTMS) caused an improved motor performance of the affected hand in stroke patients by releasing the TCI.

METHODS: We conducted a double-blind study of real versus sham rTMS in stroke patients. After patients had well- performed motor training to minimize the possibility of motor training during the motor measurement, they were randomly assigned to receive a subthreshold rTMS at the contralesional M1 (1 Hz, 25 minutes) or sham stimulation.

RESULTS: When compared with sham stimulation, rTMS reduced the amplitude of motor-evoked potentials in contralesional M1 and the TCI duration, and rTMS immediately induced an improvement in pinch acceleration of the affected hand, although a plateau in motor performance had been reached by the previous motor training. This improvement in motor function after rTMS was significantly correlated with a reduced TCI duration.

CONCLUSIONS: We have demonstrated that a disruption of the TCI by the contralesional M1 virtual lesion caused a paradoxical functional facilitation of the affected hand in stroke patients; this suggests a new neurorehabilitative strategy for stroke patients.

Stroke. 2005 Nov 3; [Epub ahead of print]

Motor Strokes.  The Lesion Location Determines Motor Excitability Changes.

Liepert J, Restemeyer C, Kucinski T, Zittel S, Weiller C.

From the Departments of Neurology and Neuroradiology, University Medical Center Eppendorf, Hamburg, and Department of Neurology, University Hospital, Freiburg, Germany.

BACKGROUND AND PURPOSE: The purpose of this research was to investigate the impact of lesion location on motor excitability and motor performance.

METHODS: We studied patients with pure motor strokes in 4 different brain areas: motor cortex lesions (n=7), striatocapsular lesions (n=13), lacunar lesions of the internal capsule (n=13), and paramedian pontine lesions (n=10). Motor performance tests included the 9-hole-peg test and grip strength recordings. Motor excitability was determined by transcranial magnetic stimulation. Motor thresholds, stimulus-response curves, silent periods, motor cortical inhibition, and facilitation were investigated.

RESULTS: The 4 groups were clinically similar but showed major differences in motor excitability. Only motor cortex lesions had a loss of intracortical inhibition in the affected hemisphere. In the internal capsule lesion group and the pontine lesion group, stimulus-response curves were depressed on the affected side. All of the subcortical lesions showed a prolongation of the silent period in the paretic side. Motor thresholds were predominantly elevated in the lesioned hemisphere of patients with internal capsule or pontine lesions. Motor performance was correlated with silent period duration in internal capsule lesions and with motor thresholds in internal capsule and pontine lesions.

CONCLUSIONS: Motor cortex lesions exhibited deficient inhibitory properties. In contrast, subcortical lesions displayed an enhancement of inhibition. Internal capsule and pontine lesions affecting the corticospinal tract on different levels particularly impaired neuronal recruitment. Our results suggest that the lesion location determines a specific pattern of motor excitability changes.

i Yi Jun Yi Da Xue Xue Bao. 2004 Aug;24(8):946-9, 952.

Effect of power-frequency electromagnetic fields on stroke during rehabilitation.

[Article in Chinese]

Deng AW, Yuang XG, Wei D, Zhang JH, Ran CF, Wang M.

Department of Rehabilitation, Longgang center Hospital of Shenzhen City, Shenzhen 518116, China. aiwen@fimmu.com

Abstract

OBJECTIVE: To explore the effects and mechanism of power-frequency electromagnetic fields on lipoprotein metabolism and homodynamic during stroke rehabilitation.

METHODS: One hundred fifteen patients with stroke were divided into 2 groups, 55 cases of them were treated by exposure to power-frequency electromagnetic fields, 60 cases were treated as control group. Barthel index and Functional Independence Measure (FIM) were used to evaluate rehabilitation outcome. The lipoprotein and its subclasses, homodynamic parameters were compared at pre- and post-rehabilitation.

RESULTS: The treatment group showed a statistically significant better prognosis compared with the control group(P<0.01). The score of Barthel index also increased after treatment(P<0.001). Total cholesterol(Tc), triglycerides(TG), low-density lipoprotein cholesterol(LDL-c) levels dropped and high-density lipoprotein cholesterol(HDL-c) increased significantly. The Tc/HDL-c, LDL-c/HDL-c ratio along with the blood and plasma viscosity decreased significantly compared with the controls (P<0.01). The ratio of stroke recurrence decreased significantly after the treatment compared with the control group (P<0.05).

CONCLUSION: The power-frequency electromagnetic fields can improve lipoprotein metabolism and homodynamic parameters. It can improve the ADL and FIM of stroke patients, which may have significant implications for stroke patients.

Vopr Kurortol Fizioter Lech Fiz Kult. 2003 Mar-Apr;(2):19-20.

Magnetic and laser therapy of acute ischemic stroke.

[Article in Russian]

Samosiuk NI.

The paper presents the technique of frequency-modulated magnetolaser therapy (FMMLT) used in combined treatment of 121 patients with ischemic stroke in acute period. The results were compared with those in the control group of 30 patients who received conventional drug treatment. The results of the comparison allowed the author to recommend FMMLT in ischemic stroke especially in the period of “therapeutic window”.

Vopr Kurortol Fizioter Lech Fiz Kult. 2001 Mar-Apr;(2):23-6.

Magnet therappy in rehabilitation of patients with cerabral ischemia.

[Article in Russian]

Provotorov VM, Putilina MV.

Abstract

Basing on the results of clinical examination and treatment of 420 patients with aftereffects of acute circulatory disturbance, the authors propose a pathogenetically grounded approach to correction of the residual phenomena following stroke. The method proposed includes three courses of impulse electromagnetotherapy used in combination with either standard chemotherapy or massage and therapeutic exercise

Vopr Kurortol Fizioter Lech Fiz Kult. 2001 Nov-Dec;(6):21-3.

The use of extremely high frequency electromagnetic fields during acute period of ischemic stroke.

[Article in Russian]

Podoliako VA, Makarchik AV.

Abstract

The rheological, coagulatory and clinical examination of 70 patients with acute ischemic stroke has demonstrated that EHF therapy (53.53 GHz) improves rheological and coagulatory parameters in such patients, has a positive effect on hemostasis and clinical course of acute ischemic stroke. The technique and doses are presented.

Stroke. 2000 Jun;31(6):1210-6.

Treatment-induced cortical reorganization after stroke in humans.

Liepert J, Bauder H, Wolfgang HR, Miltner WH, Taub E, Weiller C.

Department of Neurology, Friedrich-Schiller-University of Jena, Germany. liepert@neuro.uni-jena.de

Abstract

BACKGROUND AND PURPOSE: Injury-induced cortical reorganization is a widely recognized phenomenon. In contrast, there is almost no information on treatment-induced plastic changes in the human brain. The aim of the present study was to evaluate reorganization in the motor cortex of stroke patients that was induced with an efficacious rehabilitation treatment.

METHODS: We used focal transcranial magnetic stimulation to map the cortical motor output area of a hand muscle on both sides in 13 stroke patients in the chronic stage of their illness before and after a 12-day-period of constraint-induced movement therapy.

RESULTS: Before treatment, the cortical representation area of the affected hand muscle was significantly smaller than the contralateral side. After treatment, the muscle output area size in the affected hemisphere was significantly enlarged, corresponding to a greatly improved motor performance of the paretic limb. Shifts of the center of the output map in the affected hemisphere suggested the recruitment of adjacent brain areas. In follow-up examinations up to 6 months after treatment, motor performance remained at a high level, whereas the cortical area sizes in the 2 hemispheres became almost identical, representing a return of the balance of excitability between the 2 hemispheres toward a normal condition.

CONCLUSIONS: This is the first demonstration in humans of a long-term alteration in brain function associated with a therapy-induced improvement in the rehabilitation of movement after neurological injury.

Vopr Kurortol Fizioter Lech Fiz Kult. 2000 May-Jun;(3):17-21.

The optimization of an early rehabilitation program for cerebral stroke patients: the use of different methods of magneto- and laser therapy.

[Article in Russian]

Kochetkov AV, Gorbunov FE, Minenkov AA, Strel’tsova EN, Filina TF, Krupennikov AI.

Magnetotherapy and laser therapy were used in complex and complex-combined regimens in 75 patients after cerebral ischemic or hemorrhagic stroke starting on the poststroke week 4-5. Clinico-neurologic, neurophysiological and cerebrohemodynamic findings evidence for the highest effectiveness of neurorehabilitation including complex magneto-laser therapy in hemispheric ischemic and hemorrhagic stroke of subcortical location in the absence of marked clinico-tomographic signs of dyscirculatory encephalopathy. Complex-combined magneto-laser therapy is more effective for correction of spastic dystonia. Mutual potentiation of magnetotherapy and laser therapy results in maximal development of collateral circulation and cerebral hemodynamic reserve (84% of the patients). Complex effects manifest in arteriodilating and venotonic effects. Complex magneto-laser therapy is accompanied by reduction of hyperthrombocythemia and hyperfibrinogenemia.

Electromyogr Clin Neurophysiol. 1999 Oct-Dec;39(7):405-10.

Motor hand recovery after stroke. Prognostic yield of early transcranial magnetic stimulation.

Cruz Martínez A, Tejada J, Díez Tejedor E.

Unidad de Electromiografía, Hospital La Luz, Madrid, Spain.

Abstract

Transcranial magnetic stimulation (TMS) was performed in 20 patients within the first days after stroke. Motor evoked potentials (MEPs) were bilaterally recorded over thenar eminence muscles, and central motor conduction time (CMCT), amplitude of the MEPs (A%M) and threshold intensity compared between both sides. Six months later the patients were reexamined. Within the first days after stroke the obtention of MEPs at rest or during voluntary muscle activation have a favorable prognostic value. All patients with early response by TMS reached a good motor function in the following months. The follow-up showed that the electrophysiological improvement was closely related to clinical recovery of the hand function. However, even in cases with a good recovery, the CMCT and, mainly, the A%M, may be significantly different related to those in normal hand. TMS may be an early and valuable prognostic indicator of hand function recovery after stroke, and their prognostic yield is higher than clinical evaluation and CT study. TMS is a quantifiable method of motor disability and may have practical application in the management and rehabilitation therapy in stroke patients.

Vopr Kurortol Fizioter Lech Fiz Kult. 1996 May-Jun;(3):21-4.

The effect of combined transcerebral magnetic and electric impulse therapy on the cerebral and central hemodynamic status of stroke patients in the early rehabilitation period.

[Article in Russian]

Gorbunov FE, Orekhova EM, Isaev SV, Bugaev SA.

75 clinical cases of acute impairment of cerebral circulation treated with sinusoidal modulated currents in combination with transcerebral magnetic field have been analysed. Functional and clinical findings indicate that the above combination is much more effective than magnetic field and sinusoidal modulated currents alone: 62% against 35% and 33%, respectively.

Zh Nevrol Psikhiatr Im S S Korsakova. 1997;97(9):41-3.

Magnetic and electrical stimulation in the rehabilitative treatment of patients with organic nervous system lesions.

[Article in Russian]

Tyshkevich TG, Nikitina VV.

89 patients with organic damages of nervous system with paralyses and pareses as the main symptoms in clinical pattern were treated. Their treatment was complex with application of impulse magnetic field and electrostimulation which permitted to achieve multilevel electrostimulation. The control group was formed by 49 patients with analogous diseases which were treated by sinusoidal current electrostimulation only. Combined application of magnetic stimulation and electrostimulation was more effective. That was confirmed by data of roentgenographic and electromyographic studies.

Bioelectromagnetics. 1994;15(3):205-16.

Protection against focal cerebral ischemia following exposure to a pulsed electromagnetic field.

Grant G, Cadossi R, Steinberg G.

Department of Neurosurgery, Stanford University, California 94305.

There is evidence that electromagnetic stimulation may accelerate the healing of tissue damage following ischemia. We undertook this study to investigate the effects of low frequency pulsed electromagnetic field (PEMF) exposure on cerebral injury in a rabbit model of transient focal ischemia (2 h occlusion followed by 4 h of reperfusion). PEMF exposure (280 V, 75 Hz, IGEA Stimulator) was initiated 10 min after the onset of ischemia and continued throughout reperfusion (six exposed, six controls). Magnetic resonance imaging (MRI) and histology were used to measure the degree of ischemic injury. Exposure to pulsed electromagnetic field attenuated cortical ischemia edema on MRI at the most anterior coronal level by 65% (P < 0.001). On histologic examination, PEMF exposure reduced ischemic neuronal damage in this same cortical area by 69% (P < 0.01) and by 43% (P < 0.05) in the striatum. Preliminary data suggest that exposure to a PEMF of short duration may have implications for the treatment of acute stroke.

Zh Nevropatol Psikhiatr Im S S Korsakova. 1992;92(1):63-7.

Magnetotherapy of initial manifestations of cerebrovascular disorders in hypertension.

[Article in Russian]

Miasnikov IG.

The paper is concerned with the data on 147 subjects who underwent magnetotherapy with the unit “Magniter-AMT-01” applied to the cervical area. The main group included 102 subjects, 45 person served as control. The purpose of the work was to base the application of MT under inpatient and home conditions with the use of the above-indicated unit. In view of this fact, a study was made of cerebral hemo- and thermodynamics with the aid of rheoencephalography and encephaloradiothermography under the action of different modes of the functioning of the unit “Magniter-AMT-01” (pulse and variable magnet induction fields 12-15 mTl and 30-35 mTl). A method of measuring magnetosensitivity of patients depending on the temperature reaction of the brain to a single MT session was elaborated. The greatest clinical effect was attained with the use of pulse magnetic field 15 mTl. Magnetotherapy with the use of the unit “Magniter-AMT-01” provided good results under inpatient and home conditions. The magnetosensitive patients demonstrated the highest effect.

J Cell Biochem. 1993 Apr;51(4):387-93.

Beneficial effects of electromagnetic fields.

Bassett CA.

Bioelectric Research Center, Columbia University, Riverdale, New York 10463.

Selective control of cell function by applying specifically configured, weak, time-varying magnetic fields has added a new, exciting dimension to biology and medicine. Field parameters for therapeutic, pulsed electromagnetic field (PEMFs) were designed to induce voltages similar to those produced, normally, during dynamic mechanical deformation of connective tissues. As a result, a wide variety of challenging musculoskeletal disorders have been treated successfully over the past two decades. More than a quarter million patients with chronically ununited fractures have benefitted, worldwide, from this surgically non-invasive method, without risk, discomfort, or the high costs of operative repair. Many of the athermal bioresponses, at the cellular and subcellular levels, have been identified and found appropriate to correct or modify the pathologic processes for which PEMFs have been used. Not only is efficacy supported by these basic studies but by a number of double-blind trials. As understanding of mechanisms expands, specific requirements for field energetics are being defined and the range of treatable ills broadened. These include nerve regeneration, wound healing, graft behavior, diabetes, and myocardial and cerebral ischemia (heart attack and stroke), among other conditions. Preliminary data even suggest possible benefits in controlling malignancy.