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Mixed effectiveness of rTMS and retraining in the treatment of focal hand dystonia.

Kimberley TJ, Schmidt RL, Chen M, Dykstra DD, Buetefisch CM - Front Hum Neurosci (2015)

Bottom Line: Contrary to our hypothesis, group analyses revealed no additional benefit from the SMR training vs.The patient rated improvements were accompanied by a moderate effect size suggesting clinical meaningfulness.These results provide encouragement for further investigation of rTMS in FHD with a need to optimize a secondary intervention and determine likely responders vs. non-responders.

View Article: PubMed Central - PubMed

Affiliation: Program in Physical Therapy, Brain Plasticity Laboratory, Department of Physical Medicine and Rehabilitation, University of Minnesota Minneapolis, MN, USA.

ABSTRACT

Unlabelled: Though the pathophysiology of dystonia remains uncertain, two primary factors implicated in the development of dystonic symptoms are excessive cortical excitability and impaired sensorimotor processing. The aim of this study was to determine the functional efficacy of an intervention combining repetitive transcranial magnetic stimulation (rTMS) and sensorimotor retraining. A randomized, single-subject, multiple baseline design with crossover was used to examine participants with focal hand dystonia (FHD) (n = 9).

Intervention: 5 days rTMS + sensorimotor retraining (SMR) vs. Five days rTMS + control therapy (CTL) (which included stretching and massage). The rTMS was applied to the premotor cortex at 1 Hz at 80% resting motor threshold for 1200 pulses. For sensorimotor retraining, a subset of the Learning-based Sensorimotor Training program was followed. Each session in both groups consisted of rTMS followed immediately by 30 min of the therapy intervention (SMR or CTL). Contrary to our hypothesis, group analyses revealed no additional benefit from the SMR training vs. CTL. When analyzed across group however, there was significant improvement from the first baseline assessment in several measures, including tests of sensory ability and self-rated changes. The patient rated improvements were accompanied by a moderate effect size suggesting clinical meaningfulness. These results provide encouragement for further investigation of rTMS in FHD with a need to optimize a secondary intervention and determine likely responders vs. non-responders.

No MeSH data available.


Related in: MedlinePlus

Global rating of change (GROC) scores from first baseline to all subsequent assessments. This graph demonstrates mean change (±SE) over time, excluding one participant (#7) who appeared to misunderstand the rating (see text). Note, all individuals received both interventions. CTL-SMR (light gray) received the rTMS + CTL first and then the rTMS + SMR in Phase 2. The SMR-CTL (dark gray) group received rTMS + SMR first and then rTMS + CTL in Phase 2. GROC was assessed at one baseline, post-test and follow up for each phase. (SMR, sensorimotor retraining; rTMS, repetitive transcranial magnetic stimulation; CTL, control).
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Figure 2: Global rating of change (GROC) scores from first baseline to all subsequent assessments. This graph demonstrates mean change (±SE) over time, excluding one participant (#7) who appeared to misunderstand the rating (see text). Note, all individuals received both interventions. CTL-SMR (light gray) received the rTMS + CTL first and then the rTMS + SMR in Phase 2. The SMR-CTL (dark gray) group received rTMS + SMR first and then rTMS + CTL in Phase 2. GROC was assessed at one baseline, post-test and follow up for each phase. (SMR, sensorimotor retraining; rTMS, repetitive transcranial magnetic stimulation; CTL, control).

Mentions: In contrast to our expectations, mean GROC scores did not return to zero following the washout period, which would indicate a return to the previous level of function (Figure 2). This suggests a carryover effect from the participants' first intervention into the beginning of the second intervention. There was no difference in carryover effect between treatments.


Mixed effectiveness of rTMS and retraining in the treatment of focal hand dystonia.

Kimberley TJ, Schmidt RL, Chen M, Dykstra DD, Buetefisch CM - Front Hum Neurosci (2015)

Global rating of change (GROC) scores from first baseline to all subsequent assessments. This graph demonstrates mean change (±SE) over time, excluding one participant (#7) who appeared to misunderstand the rating (see text). Note, all individuals received both interventions. CTL-SMR (light gray) received the rTMS + CTL first and then the rTMS + SMR in Phase 2. The SMR-CTL (dark gray) group received rTMS + SMR first and then rTMS + CTL in Phase 2. GROC was assessed at one baseline, post-test and follow up for each phase. (SMR, sensorimotor retraining; rTMS, repetitive transcranial magnetic stimulation; CTL, control).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496570&req=5

Figure 2: Global rating of change (GROC) scores from first baseline to all subsequent assessments. This graph demonstrates mean change (±SE) over time, excluding one participant (#7) who appeared to misunderstand the rating (see text). Note, all individuals received both interventions. CTL-SMR (light gray) received the rTMS + CTL first and then the rTMS + SMR in Phase 2. The SMR-CTL (dark gray) group received rTMS + SMR first and then rTMS + CTL in Phase 2. GROC was assessed at one baseline, post-test and follow up for each phase. (SMR, sensorimotor retraining; rTMS, repetitive transcranial magnetic stimulation; CTL, control).
Mentions: In contrast to our expectations, mean GROC scores did not return to zero following the washout period, which would indicate a return to the previous level of function (Figure 2). This suggests a carryover effect from the participants' first intervention into the beginning of the second intervention. There was no difference in carryover effect between treatments.

Bottom Line: Contrary to our hypothesis, group analyses revealed no additional benefit from the SMR training vs.The patient rated improvements were accompanied by a moderate effect size suggesting clinical meaningfulness.These results provide encouragement for further investigation of rTMS in FHD with a need to optimize a secondary intervention and determine likely responders vs. non-responders.

View Article: PubMed Central - PubMed

Affiliation: Program in Physical Therapy, Brain Plasticity Laboratory, Department of Physical Medicine and Rehabilitation, University of Minnesota Minneapolis, MN, USA.

ABSTRACT

Unlabelled: Though the pathophysiology of dystonia remains uncertain, two primary factors implicated in the development of dystonic symptoms are excessive cortical excitability and impaired sensorimotor processing. The aim of this study was to determine the functional efficacy of an intervention combining repetitive transcranial magnetic stimulation (rTMS) and sensorimotor retraining. A randomized, single-subject, multiple baseline design with crossover was used to examine participants with focal hand dystonia (FHD) (n = 9).

Intervention: 5 days rTMS + sensorimotor retraining (SMR) vs. Five days rTMS + control therapy (CTL) (which included stretching and massage). The rTMS was applied to the premotor cortex at 1 Hz at 80% resting motor threshold for 1200 pulses. For sensorimotor retraining, a subset of the Learning-based Sensorimotor Training program was followed. Each session in both groups consisted of rTMS followed immediately by 30 min of the therapy intervention (SMR or CTL). Contrary to our hypothesis, group analyses revealed no additional benefit from the SMR training vs. CTL. When analyzed across group however, there was significant improvement from the first baseline assessment in several measures, including tests of sensory ability and self-rated changes. The patient rated improvements were accompanied by a moderate effect size suggesting clinical meaningfulness. These results provide encouragement for further investigation of rTMS in FHD with a need to optimize a secondary intervention and determine likely responders vs. non-responders.

No MeSH data available.


Related in: MedlinePlus