Post-stroke Hemichorea Responding to Repetitive Transcranial Magnetic Stimulation Using a Parabolic Coil: A Case Report

Abstract

Background: Hemichorea is a common post-stroke movement disorder. Although the general prognosis is good, permanent functional impairment remains in a substantial number of patients with post-stroke hemichorea. Anti-choreic drugs may alleviate symptoms in mild cases, but they often incur unacceptable side effects like tardive dyskinesia and parkinsonism. Surgery is rarely indicated for the treatment of vascular chorea, except in refractory cases. Case presentation: Here we reported a case of a 71-year-old man with severe choreatic movements after stroke, which caused the inability to perform the activities of daily living. Computed tomography revealed signs of former bleeding in the left caudate nucleus. Due to poor response to pharmacologic treatment, he was subjected to physical therapy and repetitive magnetic stimulation (rTMS) using a parabolic coil with 1 Hz over the left M1 area. The patient reported reduced symptoms after the 1st week of stimulation. rTMS substantially reduced choreatic movements and improved functional scores, including Brunnstrom recovery stage, Fugl–Meyer Assessment, Barthel index, Berg balance scale, and Dyskinesias scale. After 4 weeks of therapy, he was discharged with only a slight involuntary movement on the left side. No relapse occurred during the 1-year follow-up. Conclusions: Further studies are needed to reveal the mechanism of the observed effects and confirm the efficacy of rTMS as an alternative treatment for severe post-stroke hemichorea.