Ann Rehabil Med.  2020 Dec;44(6):428-437. 10.5535/arm.20093.

Comparison of Repetitive Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation on Upper Limb Recovery Among Patients With Recent Stroke

• Doris Miu KY
• Kok C
• Leung SS
• Chan EYL
• Wong E

• KMID: 2510810
• DOI: http://doi.org/10.5535/arm.20093

Abstract

Objective
To compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on upper limb function recovery among patients who recently had stroke.
Methods
Subjects with recent stroke (within 1 month) were randomized to rTMS (n=25) and tDCS (n=26) applied over the non-lesioned hemisphere for three sessions per week, followed by tailored upper limb rehabilitation training for a total of 2 weeks. The primary outcomes were changes in the Motor Assessment Scale (MAS), Fugl-Meyer arm score test, Nine-Hole Peg Test (9HPT), hand grip strength, and modified Barthel Index at weeks 2 and 4. Both therapists responsible for training and assessment were blinded to the intervention allocated.
Results
There was an improvement in all the motor performance scales among both groups (p<0.001). These improvements persisted at discharge. However, there was no significant difference in any of the assessment scales between the two groups. The rTMS group showed a statistically non-significant greater improvement in MAS, 9HPT, and handgrip strength than the tDCS group.
Conclusion
Both interventions produce a statistically significant improvement in upper limb function. There was no statistically significant difference between the two intervention methods with respect to motor performance. It is suggested that a larger study may help to clarify the superiority of either methods.

Keyword

Transcranial direct current stimulation (tDCS); Transcranial magnetic stimulation; rTMS; Stroke; Upper limb motor recovery

Figure

• 

  Fig. 1. The consort flow diagram. rTMS, repetitive transcranial magnetic stimulation; tDCS, transcranial direct current stimulation.

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  Fig. 2. The within group changes in functional outcome: (A) rTMS group and (B) tDCS group. Each line represents functional outcome scores. rTMS, repetitive transcranial magnetic stimulation; tDCS, transcranial direct current stimulation; MAS, Motor Assessment Scale; FM, Fugl-Meyer arm score test; 9HPT, Nine-Hole Peg Test; mBI, modified Barthel Index.

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  Fig. 3. The between group differences in functional outcome. Changes in (A) MAS, (B) FM, (C) 9HPT, (D) handgrip strength, and (E) mBI from baseline. Each bar and 95% confidence interval (CI) represent the changes in functional scores in the rTMS group and tDCS group. rTMS, repetitive transcranial magnetic stimulation; tDCS, transcranial direct current stimulation; MAS, Motor Assessment Scale; FM, Fugl-Meyer arm score test; 9HPT, Nine-Hole Peg Test; mBI, modified Barthel Index.

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