Article 1 Effects of Excitatory Transcranial Magnetic 2 Stimulation of the Anterior Intraparietal Area in 3 Chronic Stroke Patients 4 Ronaldo Luis da Silva, 1, * Angela Maria Costa de Souza, 2 Francielly Ferreira Santos, 2 Sueli 5 Toshie Inoue, 2 Johanne Higgins 3 and Victor Frak 1 6 1 Faculté des Sciences, Université du Québec à Montréal, Montreal, Quebec, Canada; 7 (da_silva.ronaldo_luis@courrier.uqam.ca, RLS; frak.victor@uqam.ca, VF) 8 2 Centro de Reabilitação e de Readaptação Dr Henrique Santillo – CRER, Goiânia, Goiás, Brazil; 9 (angelamcsouza52@gmail.com, AMCS; francielly.fisio2010@gmail.com, FFS; inoue.sueli@gmail.com, STI) 10 3 École de Réadaptation, Faculté de Médecine, Université de Montréal, Québec, Canada; 11 (johanne.higgins@umontreal.ca) 12 * Correspondence: rlsfisio@gmail.com; Tel.: +1-514-559-6405 13 Abstract: 1) Objective: to evaluate the effects of excitatory transcranial magnetic stimulation of the 14 anterior intraparietal area in chronic patients with a frontal lesion and parietal sparing due to stroke 15 on the impaired upper (UL) and lower limb (LL) as measured by Fugl-Meyer Assessment (FMA). 16 2) Methods: three patients (P1: 49.83/2.75, P2: 53.17/3.83, P3:63.33/3.08 years-old at stroke/years post- 17 stroke, respectively) received two weeks (five days/ week) of rTMS at 10 Hz of the left anterior 18 intraparietal area (AIP). A patient was treated in similar conditions with a sham coil (56.58/4.33) No 19 complimentary therapy was delivered during the study. Patients were evaluated before, after- and 20 two-months post-treatment (A1, A2 and A3, respectively). 3) Results: We found increased scores for 21 lower limb in motor function subsection for P1 and P3 and in sensory function for P2 by A2 that 22 remained at A3. We also found an increased score for upper limb motor function for P2 and P3, but 23 the score decreased by A3 for P2. P3 score for upper limb ROM increased by A3 compared to A1 24 and A2. 4) Conclusion: AIP excitatory rTMS increased the FMA scores for lower and upper limb 25 function, showing a broader effect when compared to M1 stimulation. 26 Keywords: anterior intraparietal area; stroke; rTMS; Fugl-Meyer Assessment; fast frequency TMS; 27 motricity; sensibility; chronic patients 28 29 1. Introduction 30 TMS is a widely studied tool for the treatment of post-stroke patients. Several studies have 31 obtained promising results for treating depression [1,2], aphasia [3-6] and pain [7-10], as well as for 32 improving motor function [2,11-14]. Such studies are generally based upon the interhemispheric 33 imbalance model [15], which states that the injury of one hemisphere increases the activation of the 34 contralateral hemisphere, which, in turn, exerts a greater inhibition over the injured hemisphere [15- 35 17]. Most of these studies have applied the inhibitory repetitive transcranial magnetic stimulation 36 (rTMS) to the intact hemisphere and excitatory rTMS to the injured hemisphere [3,13,15,]. Excitatory 37 stimulation, however, does not only present opposite results from inhibitory stimulation. Its results 38 tend to be broader and more intense, whereas inhibitory stimulation, tends to generate changes in a 39 smaller number of cortical centers with a lower intensity [17,18]. Some researchers have applied the 40 excitatory stimulation on the usually inhibited unlesioned hemisphere in patients with depression or 41 aphasia [5,19], and they found similar or more consistent results compared to those obtained by 42 inhibitory stimulation. These studies seem to indicate that the utility of the excitatory TMS on the 43 post-stroke brain is not restricted to the model of inter-hemispheric imbalance. 44 Studies evaluating the effects of rTMS on motor function have typically used the primary motor 45 cortex as the stimulation site [7,8,11-14,20]. These studies have obtained good results with acute [13] 46 Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 2 March 2018 doi:10.20944/preprints201803.0018.v1 © 2018 by the author(s). Distributed under a Creative Commons CC BY license.