A recent case study revealed a potential new therapy to help chronic stroke patients regain arm or hand mobility. The therapy is Transcranial Magnetic Stimulation (TMS). TMS uses magnetic pulses over a person’s head to change electrical activity deep inside the brain. This technology has been used to treat many psychiatric conditions such as depression.
After an ischemic brainstem stroke left him nearly paralyzed, a 61-year-old man suffered from tetraparesis. This is a severe weakness in all four limbs, as well as an incomplete locked-in syndrome. Because he had lost almost all control of his voluntary muscles, he was fully conscious but “locked-in”. His body was nearly paralyzed and couldn’t do what he wanted it to. Thankfully, he had just enough mobility in his right hand to operate an electric wheelchair, giving him the small but precious freedom of mobility.
As if things couldn’t get any worse, the patient also developed auditory hallucinations 4 years after the stroke. These hallucinations kept him from sleeping and even made him aggressive to his family and friends. Psychiatric medications couldn’t help him, and he suffered terrible side effects from them too. When it seemed that all hope was lost, doctors offered TMS. Since the medications weren’t working to relieve the hallucinations, they decided to give TMS a try.
Unexpected improvements after 6 years
Almost 6 years after the stroke, TMS was finally able to give this man a little bit of his life back! Not only have his auditory hallucinations disappeared, but his right hand surprisingly regained function too. For the first time since his stroke, he can fully open his right hand and extend his fingers. Now, the patient uses his wheelchair with ease and is able to shake hands with people he meets. Since it’s rare for people to spontaneously regain hand function so long after a stroke, it’s likely that TMS played a role in this case.
Nobody knew that TMS therapy could potentially help recover hand function. The physicians and scientists were not prepared in this case to make accurate measures of hand function while the man was undergoing treatment, so there is no evidence that TMS was able to have such an effect. However, they still believe that this remarkable recovery warrants further investigation. This important discovery could represent a new, non-invasive treatment that can help patients regain their muscle control and live better lives after a stroke.
TMS is promising but expensive. A full course of treatment can cost between $8,000 to $10,000. And not all insurances cover this. That’s why it is important to discuss the details of your coverage with your insurance provider before starting this treatment.
The first author of this study is Fanny Thomas from Unité de Recherche Clinique, Etablissement Public de Santé Ville-Evrard, Neuilly sur Marne, France.
What you can do with this information
This case study shows how unexpected discoveries can give rise to new treatments for arm and hand function, even for patients in the chronic phase.