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. Author manuscript; available in PMC: 2016 May 29.
Published in final edited form as: Handb Clin Neurol. 2013;116:499–524. doi: 10.1016/B978-0-444-53497-2.00040-1

Table 40.3.

Summary of previous studies investigating the effectiveness of inhibitory and facilitatory rTMS or tDCS over primary motor cortex of unaffected and affected hemisphere on motor behavior

Technique Reference Area of stimulation No. of patients, mean age, lesion location, and time since stroke Study design Control condition Stimulation parameters Main results
tDCS, anodal, cathodal Fregni et al., 2005 Hand area of M1, unaffected hemisphere, affected hemisphere 6 adults, 53.67 years, 3 cortical, 3 subcortical, 27.08 months Single-blind, crossover, randomized, sham- controlled Sham tDCS, anodal tDCS over affected hemisphere, cathodal tDCS over unaffected hemisphere 1 mA, 20 min Both anodal and cathodal tDCS improved motor performance in the Jebsen–Taylor Hand Function Test
tDCS, anodal, cathodal Boggio et al., 2007 Hand area of M1, unaffected hemisphere, affected hemisphere 9 adults, 57 years, 9 subcortical, 13–85 months Exp. 1: double- blind. Exp. 2: crossover, longitudinal; randomized, sham- controlled Sham tDCS, anodal tDCS over affected hemisphere, cathodal tDCS over unaffected hemisphere Intensity 1 mA, 20 min, administered once (exp. 1), only cathodal daily over 5 consecutive days (exp. 2) Improvement in Jebsen–Taylor Hand Function Test immediately after tDCS. Greater cumulative improvement after 5 days of tDCS (lasting for 14 days)
tDCS, anodal, cathodal Stagg et al., 2012 Hand area of M1, unaffected hemisphere, affected hemisphere 12 adults, 63.47 years, 7 subcortical, 6 cortical, average 33.8 months Single-blind, randomized, crossover, sham- controlled Sham tDCS, anodal tDCS over affected hemisphere, cathodal tDCS over unaffected hemisphere 1 mA, 20 min Anodal tDCS led to significant improvements in RTs with affected hand, associated with an increase in movement-related cortical activity in stimulated M1 and functionally interconnected regions. Cathodal tDCS led to a functional improvement only when compared with sham stimulation
rTMS, cTBS, iTBS Talelli et al., 2007 Hand area of M1, unaffected hemisphere, affected hemisphere 6 adults, 57.7 years, 3 cortical, 3 subcortical, 31 months Single-blind, crossover, sham- controlled Real TMS, sham TMS (sham coil) cTBS (300 pulses, 80% aMT), iTBS (600 pulses, 80% aMT) cTBS suppressed MEPs evoked in healthy hands but did not change motor behavior or electrophysiology of paretic hands. iTBS transiently improved motor behavior and corticospinal output in paretic hands
rTMS, cTBS, iTBS Di Lazzaro et al., 2008 Hand area of M1, unaffected hemisphere, affected hemisphere 12 adults, 69.4 years, 4 cortical, 8 subcortical, 12 healthy, average 5.1 days. Control subjects, mean age 63.2 years Single-blind, No sham- controlled, but healthy control group, crossover cTBS over unaffected hemisphere, iTBS over affected hemisphere cTBS (600 pulses, 80% aMT), iTBS (800 pulses, 80 % aMT) In patients, both iTBS and cTBS produced a significant increase in amplitude of MEPs evoked by stimulation of affected hemisphere. Effects in patients comparable to those in controls
rTMS, low frequency, high frequency Khedr et al., 2009 Hand area of M1, unaffected hemisphere, affected hemisphere 36 adults, 57.9 years, 19 cortical, 17 subcortical, average 17.1 days Single-blind, randomized, longitudinal, sham- controlled 36 patients, 12 real 1-Hz TMS over unaffected hemisphere, 12 real 3-Hz TMS over affected hemisphere, 12 sham TMS 1-Hz TMS, 100% rMT, 900 pulses, 3-Hz TMS, 130% rMT, 900 pulses, daily over 5 days At 3-month time point, both real rTMS groups had improved significantly more in different rating scales (NIH Stroke Scale and Barthel Index Scale) than sham group; in addition, 1-Hz group performed better than 3-Hz group in NIH Stroke Scale
rTMS, cTBS, iTBS Ackerley et al., 2010 Hand area of M1, unaffected hemisphere, affected hemisphere 10 adults, 60 years, 10 subcortical, average 28 months Double-blind, crossover, sham- controlled cTBS, over unaffected hemisphere, iTBS over affected hemisphere, sham (sham coil) cTBS (600 pulses), iTBS (600 pulses), 90% aMT TBS and training led to task- specific improvements in grip- lift. Specifically, cTBS of contralesional M1 led to an overall decrement in upper-limb function
rTMS, low frequency, high frequency Emara et al., 2010 Hand area of M1, unaffected hemisphere, affected hemisphere 60 adults, 53.9 years, average 4.1 months Single-blind, randomized, longitudinal, sham- controlled 60 patients, 20 real 1-Hz TMS over unaffected hemisphere, 20 real 5-Hz TMS over affected hemisphere, 20 sham (perpendicular to scalp) 1 Hz, 110120% rMT, 150 pulses, 5 Hz, 80–90% rMT, 750 pulses, 10 daily sessions+PT Real rTMS improved finger tapping test, Activity Index score, and modified Rankin Scale in both groups. Effect sustained over 12-week observation period
rTMS, low frequency, high frequency Sasaki et al., 2011 Hand area of M1, unaffected hemisphere, affected hemisphere 29 adults, 65.7 years, 6–29 days Single-blind, randomized, longitudinal, sham- controlled 29 patients, 11 real 1-Hz TMS over unaffected hemisphere, 9 real 10-Hz TMS over affected hemisphere, 9 sham (perpendicular to scalp) 1 Hz, 1800 pulses, 10 Hz, 1000 pulses, 5 days, consecutive sessions Both real rTMS groups had significant increases in both grip strength and tapping frequency. More increase in 10-Hz group vs sham
rTMS, low frequency, high frequency, bihemispheric Takeuchi et al., 2009 Hand area of M1, unaffected hemisphere, affected hemisphere 30 adults, 59.3 years, 30 subcortical, average 28.8 months Double-blind, randomized 30 patients, 10 real bihemispheric TMS (alternating 1 Hz vs 10 Hz, 1000 pulses for each hemisphere, 90% rMT), 10 real 1-Hz TMS over unaffected hemisphere and sham 10 Hz over unaffected hemisphere, 10 real 10-Hz TMS over affected hemisphere and sham 1-Hz TMS over unaffected hemisphere 1 Hz vs 10 Hz, 1000 pulses for each hemisphere, 90% rMT, after TMS 15 min motor training Bilateral and 1-Hz rTMS improved acceleration in paretic hand. Compared with 1 Hz, bihemispheric rTMS decreased inhibitory function of affected motor cortex and enhanced effect of motor training on pinch force. 10-Hz rTMS had no effect on motor function

aMT, active motor threshold; cTBS, continuous theta-burst stimulation; exp., experiment; iTBS, intermittent theta-burst stimulation; M1. primary motor cortex; MEP, motor evoked potential; NIH, National Institutes of Health; PT, physical training; RT, reaction time; rTMS, repetitive transcranial magnetic stimulation; tDCS, transcranial direct current stimulation.