Low-frequency rTMS combined with intensive occupational therapy for upper limb hemiparesis after brain tumour resection.

Objective: To assess the safety, feasibility and efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with occupational therapy (OT) in a hemiparetic patient who had undergone brain tumour resection.

Participant: A 39-year-old right-handed woman underwent brain tumour resection and presented 5 years later with right upper limb hemiparesis. At admission, she was considered to have reached a probable plateau state of motor functional recovery of the affected upper limb in spite of conventional occupational therapy.

Intervention: Low-frequency rTMS with 1 Hz applied to the right primary motor cortex followed by intensive occupational therapy (one-on-one training and self-training) was provided daily during the 15-day hospitalization.

Main Outcome Measures: Fugl-Meyer Assessment and Wolf Motor Function Test were conducted serially to evaluate motor function on the affected upper limb.

Results: Neither adverse effect nor deterioration of neurological symptoms was recognized during the treatment period. The 15-day combination protocol improved motor function of the right upper limb and further improvement was noted 4 weeks after discharge.

Conclusion: The proposed protocol of low-frequency rTMS with intensive occupational therapy is a potentially useful rehabilitative programme for upper limb hemiparesis after brain tumour resection.