Combined therapeutic application of botulinum toxin type A, low-frequency rTMS, and intensive occupational therapy for post-stroke spastic upper limb hemiparesis
European Journal of Physical and Rehabilitation Medicine, 05/01/2012

Kakuda W et al. – The beneficial effect of the protocol on motor function and spasticity was almost maintained until four weeks after discharge. The protocol is safe and feasible.

• In all patients, BoNTA was injected into spastic muscles of the affected upper limb (maximum total dose: 240 units).
• Four weeks later, they were hospitalized to receive 22 sessions of 20-min LF-rTMS and 120-min intensive OT daily over 15 days.
• Motor function of the affected upper limb was evaluated mainly using Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), motor activity log (MAL), and the severity of spasticity was measured with modified Ashworth scale (MAS) at BoNTA injection, discharge and four weeks post-discharge.

• All patients completed the protocol without any adverse effects.
• The FMA score and MAL scores, but not WMFT performance time, improved significantly at discharge.
• The MAS score of all examined muscles decreased significantly between BoNTA and discharge.