High-frequency rTMS applied over bilateral leg motor areas combined with mobility training for gait disturbance after stroke: A preliminary study

Objective: A double cone coil enables delivery of magnetic stimulation to leg motor areas and modulates neural activities of the areas. It is expected that combined application of facilitatory rTMS with the coil and physical therapy would improve walking function after stroke. The purpose of this study is to clarify the clinical effect of an in-patient protocol featuring rTMS with a double cone coil and mobility training for gait disturbance after stroke. Subjects and methods: Nineteen post-stroke hemiparetic patients with gait disturbance were studied (aged 56.2 +/- 11.9 years). During the 13-day hospitalization, each patient received 20 sessions of high-frequency rTMS and mobility training featuring treadmill training. In one rTMS session, 2000 pulses of 10-Hz rTMS were delivered over bilateral leg motor areas using the double cone coil. Walking velocity, Physiological Cost Index (PCI) and Timed Up and Go Test (TUG) were evaluated on the day of admission and discharge. Results: The protocol was completed without any adverse effects in all patients. The combination treatment significantly increased walking velocity (p<0.05) and decreased PCI (p<0.05), decreased the performance time for TUG (p<0.05). Conclusions: The protocol featuring high-frequency rTMS and mobility training is safe and feasible and can improve walking function after stroke.