Effect of Low Frequency Cerebellar Repetitive Transcranial Magnetic Stimulation on Balance Impairment in Patients With Cerebral Infarction

Abstract

Objective To investigate the effect of low frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) on balance impairment in patients with cerebral infarction.Methods Thirty-two patients were randomly divided into two groups: rTMS group (n=16) and control (n=16). In the rTMS group, treatment was performed five times per week for 2 weeks (10 sessions), and in the control group, a sham coil was used with the sound and sensation of scalp similar to the rTMS coil. Patients in both groups underwent a conventional rehabilitation program. Berg Balance Scale (BBS) was used as the primary outcome measurement. Timed Up and Go test (TUG), 10-m walk test (10mWT), and Activity-specific Balance Confidence scale (ABC) were used as the secondary outcome measurement. All scales were measured at baseline (T0), after 10 sessions of rTMS (T1), and at 4 weeks after treatment completion (T2) by therapists with over 5 years of clinical experience.Results There were significant improvements between T0 and T1, and between T0 and T2, for all assessed items in the rTMS group. Whereas there were significant improvements between T0 and T1, and between T0 and T2, for the BBS and 10mWT in the control group. TUG (-4.87±5.05 vs. -0.50±2.97 seconds) and ABC score (8.10±8.33 vs. 0.16±0.97) were observed significant differences in comparison of the changes from T0 to T1 between the two group. BBS score (4.40±3.66 vs. 1.88±3.14), TUG (-4.87±4.56 vs. -0.62±2.96 seconds) and ABC score (8.22±7.70 vs. -0.09±0.86) differed significantly from T0 to T2 between the two groups.Conclusion Our findings suggest that low-frequency cerebellar rTMS is helpful for improving balance in patients with cerebral infarction, and maybe a beneficial treatment for these patients.

Cerebellar transcranial magnetic stimulation for improving balance capacity and activity of daily living in stroke patients: a systematic review and meta-analysis

“…After reviewing all relevant outcome data of included studies, 1 study’s data [ 22 ] could be used directly, 10 studies’ data [ 21 , 24 , 25 , 27 – 33 ] were calculated by the formula in the data synthesis and analysis section, 2 studies’ data [ 20 , 26 ] were obtained through GetData software.10 studies only assessed the post-intervention effects of cerebellar TMS on balance capacity and/or ADL. 3 studies assessed both the post-intervention and follow-up effects of cerebellar TMS on balance capacity and/or ADL.…”

“…Eight studies [ 21 , 25 , 26 , 28 , 30 – 33 ] with 357 stroke participants were pooled to estimate the overall effect of cerebellar TMS on BBS score. The pooled results from 8 studies with 357 participants showed that cerebellar TMS could significantly improve the post-intervention BBS score (MD = 4.24, 95%CI = 2.19 to 6.29, P < 0.00001; heterogeneity, I 2 = 74%, P = 0.0003; Fig.…”

“…The pooled results from 3 studies [ 21 , 25 , 26 ] with 97 participants showed that cerebellar TMS could significantly improve the BBS score at the end of follow-up (MD = 6.29, 95%CI = 3.81 to 8.77, P < 0.00001; heterogeneity, I 2 = 0%, P = 0.42; Fig. 2 ).…”

“…Only 1 study [ 21 ] reported the effect of cerebellar TMS on TUG at the end of follow-up, with no significant improvement (Fig. 3 ).…”

Bilateral Cerebellar Repetitive Transcranial Magnetic Stimulation for Chronic Ataxia After Hemorrhagic Stroke: a Case Report

“…A small number of clinical trials have demonstrated that repetitive Transcranial Magnetic Stimulation (rTMS) has some e cacy for reducing symptom burden in patients with cerebellar ataxia with differing etiologies, using varying treatment protocols [3]. In studies exploring post-stroke syndromes speci cally, rTMS using 1 Hz stimulation targeting the ipsilateral cerebellar hemisphere has been shown to signi cantly improve ataxia as measured by the 10-meter walk test (10MWT), Berg Balance Scale (BBS), or Timed Up and Go test (TUG) [4][5][6]. However, no data thus far have demonstrated improvement with rTMS treatment for bilateral post-stoke cerebellar ataxia.…”