Non-invasive Neuromodulation Guided Through Biomarkers in Patients With Stroke Sequels

Project NEUROMOD: Non-invasive Neuromodulation Guided Through Biomarkers in Patients With Stroke Sequels

This study aims to investigate if the size effect of repetitive magnetic transcranial stimulation in the paretic upper limb in patients after stroke is influenced by the therapeutic decision.

After the patients and volunteers signed an informed consent form they will be classified and randomized using a website (randomization.com) by a non-involved researcher.

All patients and volunteers will be assigned to groups (arms) after being tried:

(i) rTMS-DIR: in which the patients will be submitted to a customized treatment with repetitive transcranial magnetic stimulation (rTMS) based in neurophysiological assessments; (ii) rTMS: patients will be submitted to standard treatment in the lesioned or non-lesioned hemisphere based in neurophysiological assessments; (iii) rTMS sham: each patient will receive a sham intervention that emits the same sound as the real stimulation;

In each group, the patients will be submitted to 10 sessions for two weeks, five days a week in which will receive the rTMS followed by 45 minutes of neurofunctional physiotherapy. All outcomes will be assessed before and after the 10 sessions.

Inclusion Criteria:

• More than 3 months after stroke;
• Ischemic or hemorrhagic stroke with upper limb motor impairment;

Exclusion Criteria:

• Any contraindication for application of transcranial magnetic stimulation;
• Peripheral lesions in the assessed upper limb;
• Score ≤ 18 at Folstein Mini Mental State Examination;
• Alteration of drugs that alter the excitability of the cortex (in less than 3 months);
• Application of botulinum toxin in less than 6 months.