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Magnetic Pulses May Reboot Stroke Recovery (Op-Ed)

Dr. Marcia Bockbrader, Ohio State University Wexner Medical Center | January 8, 2015

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More than 750,000 Americans experience a stroke each year in the United States. While most are not fatal, stroke kills someone every four minutes, equating to nearly 130,000 yearly deaths — and leaving a total of 7 million stroke survivors in need of some form of rehabilitation.

Those survivors face a range of potential side effects, including vision problems, memory loss and impairments in speech. The most prevalent side effect, however, is paralysis on either side of the body, which can cause loss of movement and diminished range of motion in the arms and legs. When one side of the brain is damaged by stroke, the healthy side tends to generate much more activity to compensate for the immobile side. This overcompensation can actually prevent the injured side from recovering.

In an effort to help patients regain movement on the side of their body affected by stroke, my colleagues at The Ohio State University Wexner Medical Center and I are taking part in a double-blind, randomized, placebo-controlled, Phase III trial to determine the effectiveness of repetitive transcranial magnetic stimulation (rTMS) using a device developed by NexStim, which funded our study.

After a stroke hits

Often, stroke patients can have a rapid partial recovery in the first few months after a stroke, then the spontaneous healing process slows down after about three to six months, and then slows even further after a year. This can be frustrating for patients who have a stroke that leaves one side of their body weak, making it difficult for them to do their usual everyday activities, like dressing and eating, or leisure activities like golfing.

Often, when those impairments have persisted even after completing 3 to 6 months of outpatient therapies, many patients lose hope of regaining the ability to use their weaker side.

Up to this point, doctors have not known how to reset the brain back into the state of rapid recovery that we see in the initial months after a stroke. We have been looking for a way to boost the benefits of physical and occupational therapy for motor recovery after stroke, and we think that using a powerful magnet to enhance brain plasticity prior to therapies may be the solution.

Rebooting recovery

Doctors think that part of the problem is that the healthy and injured sides of brains of some stroke patients develop an imbalance over time, either as a direct result of the tissue injury from stroke or through lack of use of the weaker side of the body. The result appears to be overactivity on the healthy side of the brain that may actually prevent the injured side from recovering. The rTMS device helps even out this imbalance by reducing activity on the side of the brain that was not injured by stroke and giving the other side a more likely chance to recover and express itself once more.

We use the navigated rTMS to essentially map the participant’s brain like a GPS system would, and then repeatedly stimulate specific areas of the motor cortex in a non-invasive manner. The rTMS device is a flat, water bottle-sized magnet that we hold against the patient’s scalp while they are reclining comfortably in a chair. The process is painless, though participants may feel the snap of the magnet pulse against their scalp or the twitch of a muscle in their arm as the device works.

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