Transcranial magnetic stimulation in the rehabilitation of motor deficits after ischemic stroke

Transcranial magnetic stimulation (TMS) was introduced to clinical practice in the 1980s and since that time has become more and more widely used. It is a noninvasive, painless brain stimulation technique that can modulate cortical excitability. It is possible to use single or paired TMS pulses, but the most promising method seems to be repetitive transcranial stimulation (rTMS) where magnetic pulses are repeated with a certain ferquency. Depending on the frequency of rTMS it is possible to activate or to inhibit the brain cortex. According to the latest research, the brain dysfunction after a stroke seems to be the matter of interhemispheric imbalance, most likely overactivation of the unaffected hemisphere. Based on this hypothesis, there are attempts to use TMS as a therapeutic tool after strokes. This review looks at the methods that use the TMS technique (rTMS – Repetitive Transcranial Magnetic Stimulation, TBS – Theta Burst Stimulation, PAS – Paired Associative Stimulation) to improve plasticity after a stroke. The effects encourage one to deepen research into TMS as a potential therapeutical tool in stroke rehabilitation. An issue of interest for future research is whether rTMS in conjunction with other stimulation parameters like standard physiotherapy could induce lasting changes in the nervous system, opening up new possibilities in rehabilitation.