Transcranial magnetic stimulation = sham TMS for motor recovery after stroke (NICHE)

Reference

Harvey RL, Edwards D, Dunning K, et al, on behalf of the NICHE Trial Investigators. Randomized sham-controlled trial of navigated repetitive transcranial magnetic stimulation for motor recovery in stroke. The NICHE trial. Stroke 2018;49(9):2138-2146.

Synopsis

This multicenter study included 199 adults with upper extremity weakness due to a stroke that happened between 3 and 12 months before enrollment. The patients were randomized to receive low-frequency (1 Hz) electric field–navigated repetitive TMS (n = 132) or sham treatment (n = 67). The treatment was applied to the uninjured portion of the motor cortex in 18 one-hour treatments over 6 weeks by a trained operator who was not masked to treatment allocation. All other study participants were unaware of treatment allocation. After 6 weeks, the main outcome—the upper extremity Fugl-Meyer score—significantly and similarly improved for each group. The authors found no meaningful differences in quality of life, spasticity, or other measures of function. The authors also report no difference between the groups in the rate of adverse events, the most common of which were arm and hand pain, spasm or myalgia, head discomfort, and paresthesias.