Deep repetitive transcranial magnetic stimulation with h-coil on lower limb motor function in chronic stroke: A pilot study

Raffaella Chieffo, Serena De Prezzo, Elise Houdayer, Arturo Nuara, Giovanni Di Maggio, Elisabetta Coppi, Laura Ferrari, Laura Straffi, Francesca Spagnolo, Svetla Velikova, Maria Sessa, Mauro Comola, Abraham Zangen, Giancarlo Comi, Letizia Leocani

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Objectives To assess the efficacy of high-frequency (20Hz) brain stimulation on lower limb motor function in subjects with chronic (>6mo) subcortical stroke. Design Double-blind, placebo-controlled crossover study. Setting University hospital. Participants Right-handed subjects (N=10) affected by a first-ever subcortical stroke in the territory of the middle cerebral artery were included in this study. Interventions Repetitive transcranial magnetic stimulation (rTMS) was delivered with the H-coil, specifically designed to target deeper and larger brains regions. Each subject received both real and sham rTMS in a random sequence. The 2 rTMS cycles (real or sham) were composed of 11 sessions each, administered over 3 weeks and separated by a 4-week washout period. Main Outcome Measures Lower limb functions were assessed by the lower limb Fugl-Meyer scale, the 10-m walk test, and the 6-minute walk test before and 1 day after the end of each treatment period, as well as at a 4-week follow-up. Results Real rTMS treatment was associated with a significant improvement in lower limb motor function. This effect persisted over time (follow-up) and was significantly greater than that observed with sham stimulation. A significant increase in walking speed was also found after real rTMS, but this effect did not reach statistical significance in comparison with the sham stimulation. Conclusions These data demonstrated that 3 weeks of high-frequency deep rTMS could induce long-term improvements in lower limb functions in the chronic poststroke period, lasting at least 1 month after the end of the treatment.

Original languageEnglish
Pages (from-to)1141-1147
Number of pages7
JournalArchives of Physical Medicine and Rehabilitation
Issue number6
StatePublished - 1 Jan 2014


  • Lower limb
  • Rehabilitation
  • Stroke
  • Transcranial magnetic stimulation, repetitive

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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