Hanafi Muhammad Hafiz, Kassim Nur Karyatee, Ibrahim Al Hafiz, Adnan Munirah Mohd, Ahmad Wan Muhamad Amir W, Idris Zamzuri, Latif Lydia Abdul
School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Center for Neuroscience Services and Research, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Malays J Med Sci. 2018 Mar;25(2):116-125. doi: 10.21315/mjms2018.25.2.12. Epub 2018 Apr 27.
Stroke is one of the leading causes of mortality and morbidity in Malaysia. Repetitive transcranial magnetic stimulation (rTMS) is one of the new non-invasive modality to enhance the motor recovery in stroke patients.
This pilot study compared the motor evoked potential (MEP) changes using different settings of rTMS in the post-ischemic stroke patient. The goal of the study is to identify effect sizes for a further trial and evaluate safety aspects.
Eight post-stroke patients with upper limb hemiparesis for at least six months duration were studied in a tertiary hospital in Northeast Malaysia. Quasi experimental design was applied and the participants were randomised into two groups using software generated random numbers. One of the two settings: i) inhibitory setting, or ii) facilitatory setting have been applied randomly during the first meeting. The motor evoked potential (MEP) were recorded before and after application of the rTMS setting. A week later, a similar procedure will be repeated but using different setting than the first intervention. Each patient will serve as their own control. Repeated measures ANOVA test was applied to determine the effect sizes for both intervention through the options of partial eta-squared (η ).
The study observed large effect sizes (η > 0.14) for both rTMS settings in the lesion and non-lesion sides. For safety aspects, no minor or major side effects associated with the rTMS was reported by the participants.
The partial eta square of MEP value for both rTMS settings (fascilitatory and inhibitory) in both lesion and non-lesion sides represents large effect sizes. We recommend further trial to increase number of sample in order to study the effectiveness of both settings in ischemic stroke patient. Our preliminary data showed both settings may improve the MEP of the upper extremity in the ischemic stroke patient. No significant improvement noted when comparing both settings.
中风是马来西亚死亡和发病的主要原因之一。重复经颅磁刺激（rTMS）是增强中风患者运动恢复的一种新的非侵入性治疗方法。
这项初步研究比较了缺血性中风患者使用不同设置的rTMS时运动诱发电位（MEP）的变化。该研究的目的是确定进一步试验的效应大小并评估安全性。
在马来西亚东北部的一家三级医院对8名上肢偏瘫至少6个月的中风后患者进行了研究。采用准实验设计，使用软件生成的随机数将参与者随机分为两组。在第一次就诊时随机应用两种设置之一：i）抑制性设置，或ii）促进性设置。在应用rTMS设置之前和之后记录运动诱发电位（MEP）。一周后，将重复类似的程序，但使用与第一次干预不同的设置。每位患者将作为自己的对照。应用重复测量方差分析测试，通过偏η²（η ）选项确定两种干预的效应大小。
该研究在病变侧和非病变侧观察到两种rTMS设置均有较大的效应大小（η > 0.14）。在安全性方面，参与者未报告与rTMS相关的轻微或严重副作用。
病变侧和非病变侧两种rTMS设置（促进性和抑制性）的MEP值的偏η²均代表较大的效应大小。我们建议进一步试验以增加样本量，以便研究两种设置在缺血性中风患者中的有效性。我们的初步数据表明，两种设置均可改善缺血性中风患者上肢的MEP。比较两种设置时未发现显著改善。
