A 412-patient multi-site European trial reported that adding contralesional 1Hz inhibitory transcranial magnetic stimulation to standard motor rehabilitation produced significantly better arm motor recovery at 90 days following ischemic stroke than rehabilitation alone. The trial enrolled patients within two weeks of stroke onset.
The treatment rationale is that the unaffected hemisphere becomes hyperactive after stroke and may inhibit recovery of the affected hemisphere via interhemispheric inhibition. Suppressing the unaffected side with low-frequency TMS theoretically rebalances the system and allows the lesioned hemisphere to recover function.
At 90 days, mean Fugl-Meyer Upper Extremity score improvement was 14.2 points in the TMS arm versus 9.6 in the rehabilitation-only arm — a clinically meaningful difference. Differences were largest in patients with mild-to-moderate baseline impairment; severely impaired patients showed smaller absolute gains in both arms.
U.S. stroke rehabilitation guidelines have not yet incorporated TMS. The American Stroke Association indicated the data would be reviewed at its next guidelines update. Insurance coverage for post-stroke TMS in the U.S. is currently limited and largely confined to academic centers.
Source
Reporting based on coverage from Stroke. This article is editorial summary intended for general information; it is not medical advice.