Combination Treatment of Low-Frequency rTMS and Occupational Therapy with Levodopa Administration: An Intensive Neurorehabilitative Approach for Upper Limb Hemiparesis After Stroke

• Published in: International journal of neuroscience Vol. 121; no. 7; pp. 373 - 378
• Main Authors: Kakuda, Wataru, Abo, Masahiro, Kobayashi, Kazushige, Momosaki, Ryo, Yokoi, Aki, Fukuda, Akiko, Ito, Hiroshi, Tominaga, Ayumi
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare 01.07.2011; Taylor & Francis
• Subjects: Aged; Antiparkinson Agents - adverse effects; Antiparkinson Agents - therapeutic use; Combined Modality Therapy; Female; Functional Laterality - physiology; Humans; Levodopa; Levodopa - adverse effects; Levodopa - therapeutic use; Male; Middle Aged; Muscle Spasticity - etiology; Muscle Spasticity - rehabilitation; Neuropsychological Tests; neurorehabilitation; Occupational Therapy; Paresis - drug therapy; Paresis - rehabilitation; Pilot Projects; Psychomotor Performance - physiology; Recovery of Function; repetitive transcranial magnetic stimulation; stroke; Stroke - drug therapy; Stroke Rehabilitation; Transcranial Magnetic Stimulation; Treatment Outcome; Upper Extremity; upper limb hemiparesis
• ISSN: 0020-7454; 1563-5279; 1543-5245
• DOI: 10.3109/00207454.2011.560314

ABSTRACT The combination treatment of low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy was applied with concomitant oral administration of levodopa in five post-stroke patients with upper limb hemiparesis (age at treatment: 56-66 years; interval between onset of stroke and treatment: 18-143 months) as a 15-day inpatient protocol. Daily levodopa administration of 100 mg was initiated 1 week before admission and continued until 4 weeks after discharge. Low-frequency rTMS of 1 Hz was applied to the contralesional hemisphere for 40 min daily (two 20-min sessions) combined with intensive occupational therapy consisting of 60-min one-on-one training and 60-min self-exercise. Motor function of the affected upper limb was serially evaluated with the Fugl-Meyer Assessment and the Wolf Motor Function Test. At the end of the treatment, all patients showed improved motor function in the affected upper limbs. In some patients, the improvement was maintained until 4 weeks after discharge. No patient showed any adverse effect from the intervention. Our proposed protocol featuring levodopa administration, low-frequency rTMS, and intensive occupational therapy could provide a safe and feasible intervention for upper limb hemiparesis after stroke.