Isolated pyramidal tract impairment in adult-onset Krabbe disease: A TMS study

s / Brain Stimulation 8 (2015) 326e342 332 Introduction: Stroke is one of the most disabling diseases of the nervous system. The navigated transcranial magnetic stimulation (nTMS) allows to evaluate the individual anatomy of each patient’s brain and to repeat stimulation specifically and locally, based on the individual patient’s MRI scans, That can improve effect on motor function in post-stroke rehabilitation. Aim: To examine efficacy, safety and tolerability of nTMS for stroke rehabilitation. Methods: 65 patients (mean age e 57,03 10,07 years) have been recruited in randomized double-blind sham-controlled study of repetitive nTMS of primary motor cortex (M1) for motor stroke rehabilitation. Inclusion criteria: hemispheric stroke (8 days 3 years), NIHSS 5 to 20 score for acute state, Rankin scale less than 3. Patients were randomised to 4 groups: 1. Low-frequency stimulation (LF) of intact hemisphere. (n1⁄418). 2. High frequency (HF) stimulation of damaged hemisphere (n1⁄422). 3. Both hemispheric stimulation. (n1⁄413). 4. Sham group (n1⁄412). NBS eXimia Nexstim and Magstim Rapid2 devices were used for nTMS. Patients were assessed by clinical scales before and after 10 stimulation sessions. Results: Patients in sham group did’t show any significant changes (Sign test). Patients in HF group have shown significant improvement in Fugl-Meyer scale (e 6,21 4.94(p1⁄40.001); Ashworth scale (-0,50 1,20 (p1⁄40.02); Barthel index (e 3,92 5,25 (p1⁄40.04). Significant improvement in Fugl-Meyer scale (e 10,44 10,01 (p1⁄40.0002) (fig 1) and Barthel index (e 12,81 10,64 (p1⁄40.001) were found in LF group. Only Fugl-Meyer score increase was registered in both hemispheric stimulation group (e7,11 9,24 (p1⁄40.008, ANOVA). Discussion: Our results show the relief of the post-stroke spasticity and pain after high-frequency stimulation of the affected M1. Motor improvement was demonstrated for low-frequency stimulation of