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Priming with 1-Hz rTMS over contralesional leg motor cortex does not increase the rate of regaining ambulation within 3 months of stroke: A randomized controlled trial

Huang, Ying-Zu MD, PhD; Lin, Li-Fong PT, PhD; Chang, Kwang-Hwa MD; Hu, Chaur-Jong MD; Liou, Tsan-Hon MD, PhD; Lin, Yen-Nung MD, MS
American Journal of Physical Medicine & Rehabilitation: Post Acceptance: October 10, 2017
doi: 10.1097/PHM.0000000000000850
Research Article: PDF Only



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.

*Corresponding author: Yen-Nung Lin, MD, MS, Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Address: No. 111, Section 3, Hsing-Long Rd, Taipei 116, Taiwan. Telephone: 886-2-29307930 Ext 1600. E-mail:

Acknowledgements: This study was supported by grants from Wan Fang Hospital, Taipei Medical University (104-wf-eva-11), the Ministry of Science and Technology (MOST-102-2314-B-182-030-MY3), and the Chang Gung Medical Foundation (CMRPD3E0112 and BMRP844).

Conflict of interest: none.

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