[Motor learning of the post-stroke patients presenting with upper limb paresis on the mechanotherapeutic system].

BACKGROUND: the relevance of this study arises from the high prevalence of upper limb motor impairment and pathological synergy in the post-stroke patients; these conditions are very difficult to correct with the use of the traditional rehabilitation methods. A promising but insufficiently studied approaches are the virtual reality (VR) technology as well as its combination with other techniques. AIM: The objective of the present study was to evaluate the influence of the training making use of the mechanotherapeutic system on the motor function of the paretic hand. MATERIAL AND METHODS: A total of 30 patients were enrolled in this study. The main group comprised 20 of them who completed the training course on the mechanotherapeutic system allowing for separate adjustment of weight support for the shoulder and the forearm, VR feedback with individual setting of the active working space, and augmented functional exercises. The control group consisted of the patients (n=10) who performed the task-oriented motor training course of an equal duration with arm weight support and visual feedback. RESULTS AND DISCUSSION: The assessment based on the Fugl-Meyer scale (FMA) showed the statistically significant changes in the passive motion range in the patients of both groups, but only those comprising the main group were found to experience the improvement of the major movements of the arm, wrist, and hand as well as movements outside synergy (p<0.005). Fine motor skills estimated from the results of the Action Research Arm test (ARAT) improved only in the main group due to the cylindrical and pinch grip (p<0.005). Also, only patients of the main group, improved daily living skills evaluated based on the Frenchay Arm test (FAT) (p<0.005). CONCLUSION: The results of the present study give evidence that the use of combined training with arm weight support and VR feedback contributes to a more complete recovery of motor and daily living skills in the upper limb of post-stroke patients, compared to the classical task-oriented training with visual feedback.

[Brain-Computer Interface: the First Clinical Experience in Russia].

Motor imagery is suggested to stimulate the same plastic mechanisms in the brain as a real movement. The brain-computer interface (BCI) controls motor imagery by converting EEG during this process into the commands for an external device. This article presents the results of two-stage study of the clinical use of non-invasive BCI in the rehabilitation of patients with severe hemiparesis caused by focal brain damage. It was found that the ability to control BCI did not depend on the duration of a disease, brain lesion localization and the degree of neurological deficit. The first step of the study involved 36 patients; it showed that the efficacy of rehabilitation was higher in the group with the use of BCI (the score on the Action Research Arm Test (ARAT) improved from 1 [0; 2] to 5 [0; 16] points, p = 0.012; no significant improvement was observed in control group). The second step of the study involved 19 patients; the complex BCI-exoskeleton (i.e. with the kinesthetic feedback) was used for motor imagery trainings. The improvement of the motor function of hands was proved by ARAT (the score improved from 2 [0; 37] to 4 [1; 45:5] points, p = 0.005) and Fugl-Meyer scale (from 72 [63; 110 ] to 79 [68; 115] points, p = 0.005).

[Evaluation of changes in the cortical gait control in post-stroke patients induced by the use of the "Regent" soft exoskeleton complex (SEC) by navigated transcranial magnetic stimulation].

The mechanisms underlying the locomotion recovery in poststroke patients remain unknown. Navigated transcranial magnetic stimulation (nTMS) is a new method to evaluate the functional state of the motor system. Using of the exoskeleton complex (EC) allow to correct walking pattern significantly. The aim of this study was to evaluate the capability of nTMS to assess changes in gait cortical control using EC in poststroke patients. 14 patients suffered subcortical stroke, mean age was 53.0 years [49, 62], mean duration of a stroke of 14.2 [7.0; 23.0] months were included. All patients trained with EC for 10 times and also received standardized physical therapy. All patients underwent nTMS, as well as clinical assessment using a Fugl-Meyer Scale lower extremity section and 10 m walking test before and after trains. A significant decrease of time to walk 10 meter was observed, while Fugl-Meyer Score remained unchanged. Patients showed the significant reduction of the average latency of motor responses from the affected hemisphere and different patterns of size and localization changes in both legs' cortical motor areas. Navigates TMS may demonstrate individual patterns of changes in cortical representation of leg muscles in post-stroke patients with damage of various motor system elements, while using exoskeleton complex. Thus, navigated TMS may be used not only for verification of neuroplasticity process, but it may also provide its detailed description.

[Changes in the Functional Connectivity of Motor Zones in the Use of Multimodal Exoskeleton Complex "Regent" in the Neurorehabilitation of Post-Stroke Patients].

The article discusses the effect of a course of treatment with the use of multimodal complex exoskeleton (MCE) "Regent" on the reorganization of cortical locomotor zones in 14 patients with post-stroke hemiparesis, mainly atthe chronic stage of the disease. Before the course of treatment, we identified specific areas of activation in the primary sensorimotor and supplementary motor areas and the inferior parietal lobules in both affected and healthy hemispheres by means of functional MRI (fMRI) with the use of special passive sensorimotor paradigms. After the course of treatment with MCE, we observed an improvement of temporal characteristics of walking; it was accompanied by a decrease in the activation zones of inferior parietal lobules, especially in the healthy hemisphere, and by a significant increase in the activation zone of primary sensorimotor and supplementary motor areas. The analysis of the functional connectivity of studied zones before and after the course of treatment with MCE showed significant changes in intra- and interhemispheric interactions.

[The application of high-frequency and iTBS transcranial magnetic stimulation for the treatment of spasticity in the patients presenting with secondary progressive multiple sclerosis]. / Primenenie transkranial'noi magnitnoi stimulyatsii v lechenii sindroma spastichnosti pri vtorichno-progredientnom rasseyannom skleroze.

Spasticity is considered to be a common manifestation of multiple sclerosis. Muscle relaxants are not sufficiently effective; more than that, some of them often cause a variety of adverse reactions. Transcranial magnetic stimulation (TMS) can be a promising new tool for the treatment of spasticity. The objective of the present study was to compare the effectiveness of the two TMS protocols: rhythmic (high-frequency) TMS (rTMS) and stimulation with the theta bursts (iTBS) in terms of their ability to reduce spasticity in the patients presenting with multiple sclerosis. PATIENTS AND METHODS: Twenty two patients with secondary-progressive multiple sclerosis were pseudo-randomized into two groups: those in the first (high-frequency) group received the treatment with the use of rTMS therapy at a frequency of 10 Hz; the patients of the second group, underwent stimulation with the theta bursts (iTBS). All the patients received 10 sessions of either stimulation applied to the primary motor area (M1) of both legs. The effectiveness of TMS protocols was evaluated before therapy and after 10 sessions of stimulation based on the Modified Ashworth scale (MAS), the expanded disability status scale (EDSS), and the Kurtzke functional scale (Kfs). In addition, the patients were interviewed before treatment, after 10 rTMS sessions, immediately after and within 2 and 12 weeks after the completion of the treatment using questionnaires for the evaluation of spasticity (SESS) , fatigue, and dysfunction of the pelvic organs (severity of defecation and urination disorders), fatigue. RESULTS: The study has demonstrated a significant reduction in spasticity in the patients of both groups at the end of the TMS protocol based on the MAS scale. There was no significant difference between the outcomes of the two protocols. Both had positive effect on the concomitant «non-motor¼ symptoms (fatigue, dysfunction of the pelvic organs). CONCLUSION: High-frequency transcranial magnetic stimulation (10 sessions of rTMS therapy at a frequency of 10 Hz) and stimulation with the theta-bursts applied to the M1 area in both legs can be an effective alternative treatment of spasticity in the patients with secondary-progressive multiple sclerosis. Further research is needed to detect more accurately the differences between the outcomes of the two stimulation protocols and the development of indications for their application on an individual basis.

[Autoimmune Diseases of the Nervous System: Problem Statement and Prospects].

This review highlights the achievements in the field of autoimmune diseases of the nervous system over the last 15 years. It became possible to deepen the understanding of medical and social significance of these diseases, form the concept of nosologic unit heterogeneity, describe new and atypical forms ofdemyelinating diseases of the central and peripheral nervous system, autoimmune diseases of the neuromuscular synapse. Also, it is important to mention, that the new antigens were identified, the diagnostic panel of autoantibodies was developed and put into practice. Furthermore, the dinical practice guidelinesfor the diagnosis and management of patients were developed, the new drugs were tested and included in these guidelines. The scientists of the biggest Russian neurological centre, Research Centre of Neurology (Moscow), developed a <> for immunotherapy of multiple sclerosis, studied pathomorphosis of Guillain-Barre syndrome, specified the components of its pathogenesis, improved the programs of pathogenetic therapy, which led to the decrease in mortality from 30 to 3%, helped to decrease the A VL period by 2 times, hasten the recovery of independent walking by 2.5 times. Nowadays different biomarkers of diseases of the central and peripheral nervous system are studied and modern technologies in neurorehabilitation are applied.

[STROKE: INCIDENCE AND RISK FACTORS FOR VENOUS THROMBOEMBOLIC COMPLICATIONS IN INTENSIVE CARE UNIT].

AIM: To study the evidence of venous thromboembolic complications (VTE (acute venous thrombosis (DVT) and pulmonary embolism (PE)) at the background of modern prevention for different characteristics and localization of stroke, as well as defining the role of the main clinical risk factors in the pathogenesis for ITE in stroke patients in intensive care unit. MATERIAL AND METHODS: The study included 123 patients with different types, localization and severity of stroke. All patients received standard prophylaxis VTE with low molecular weight heparin (LMWH). Neurological status, the severity of the general condition, the main clinical risk factors of stroke were assessed when income and in dynamics. There was planned duplex scanning of the veins of the inferior vena cava performed. RESULTS AND DISCUSSION: In spite of the application of modern preventive measures VTE, their frequency remains high accounting for 56%. All patients have a place DVT, in 26% of pulmonary embolism occurs. Groups at highest risk of VTE are patients with stroke more than 8 points of NIHSS, who are ventilated and assessed infection-inflammatory disorders, especially pulmonary. This group is considered to be at the highest risk of VTE. Modern preventive strategy for them is not sufficient and needs for the search of other preventive approaches.

[Long-term results of surgical treatment of patients with cerebral arterial aneurysms]. / Otdalennye rezul'taty khirurgicheskogo lecheniya patsientov s arterial'nymi anevrizmami golovnogo mozga.

OBJECTIVE: To study the long-term results of surgical treatment of patients operated on for cerebral aneurysms and their impact on functional recovery, independence and cognitive functions in the long-term period. MATERIAL AND METHODS: A multivariate regression analysis of long-term results of surgical treatment of 324 patients for cerebral aneurysms was performed (on average after 3.5 years). Upon admission of the patient to the hospital for surgical intervention, a clinical diagnostic examination was performed to confirm the diagnosis and determine the volume, timing and type of intervention. In the late period, a clinical neurological study was performed, which included an assessment of the degree of disability with the Barthel index and a modified Rankin scale, cognitive functions with MMSE, and the mental sphere with HADS. RESULTS: The severity of the condition at admission, corresponding to grade III-IV according to the Hunt-Hess classification, was the risk factor for an unfavorable prognosis for the recovery of patients in the long-term period of cerebral aneurysm surgery. The severe condition of patients at the onset of the disease increases the risk of disability by 1.9 times (p<0.05) and the risk of dementia by 6 times (p<0.05). An independent risk factor for the development of cognitive impairment is the patient's age: with an increase in age by 1 year, the MMSE score decreases by 0.27 (p<0.05). The prevalence of hemorrhage according to the Fisher classification, corresponding to grade III, is a predictor of the development of angiospasm in 91% of cases. In patients with established angiospasm, the risk of developing dementia and pre-dementia cognitive impairment was 57.3% (p<0.05). The best predictions for recovery of cognitive functions in the long-term period were observed in patients who underwent simultaneous aneurysm clipping with extra-intracranial anastomosis (mean MMSE score 25) compared with patients who underwent only aneurysm clipping (mean score 20), endovascular intervention (average score 21) or microsurgical intervention followed by intrathecal fibrinolytic injection (mean MMSE score of 20) (p<0.05). CONCLUSION: The predictors of unfavorable recovery of cognitive functions and the development of disability in the long-term period of surgical treatment of cerebral aneurysms were the severity of the condition at admission, corresponding to III-IV st. according to the Hunt-Hess classification, the age of the patient at the time of the intervention, the prevalence of hemorrhage according to Fisher, and the choice of surgical technique.

[Development of neurocritical care].

In this review we provide the definition, goals and objectives of neurocritical care, evaluation of brief history of its development. Mechanical ventilation, intracranial hypertension, neuromonitoring as underlying basics of neurocritical care approaches are discussed. The main types of pathology and specific methods used in neurocritical care units are discussed. The results of our own research on brain death--the development of national criteria; for Guillain-Barre syndrome--a double decrease in the length of mechanical ventilation and in 2.5 times of the recovery time for independent walking ability; on diphteric polyneuropathy--reduced by 11 times mortality compared with nation-wide indicators of nontraumatic persistent vegetative state--the development of diagnostic and predictive neurophysiologic criteria are demonstrated. Research data of multiple organ disfunction syndrome in severe stroke are described. Further development of neurocritical care is being discussed.

[Lower limb vein thrombosis in dynamics of acute impairments of cerebral circulation].

The present work was aimed at studying the state of the inferior vena cava system according to the findings of duplex scanning in dynamics of acute cerebral circulation impairments (ACCI). Amongst 100 patients with ACCI, lower limb vein deep thrombosis (LLVDT) was revealed in 57% of cases. The incidence of LLVDT in patients with intracerebral haemorrhage was higher than in those with ischaemic stroke, however there were no statistically significant differences between the type of ACCI (p=0.06) and subtypes of ischaemic stroke (atherothrombotic, ceardioembolic) (p = 0.68). The main risk factors for LLVDT are the presence of pronounced motion deficit in the extremities, induced by the underlying disease (p=0.02) and immobilization. In the overwhelming majority of patients (81%) thrombosis localized isolatedly in the crural veins. Ascending thrombosis and the development of a floating thrombus were represented mainly on the side of motility deficit in the extremities. We have confirmed a strong association between positive dynamics in the neurological status of patients and frequency of recanalization of thrombi (p=0.043). Ultrasonographic examination of lower limb veins in dynamics of ACCI is an important component of preventive and therapeutic process.

[Topical issues of adequate control of dyslipidemia in the prevention of acute and recurrent cerebral circulatory disorders of ischemic type]. / Aktual'nye voprosy adekvatnogo kontrolya dislipidemii v profilaktike ostrykh i povtornykh narushenii mozgovogo krovoobrashcheniya po ishemicheskomu tipu.

Ischemic stroke (IS) is one of the main causes of death and permanent disability. Reducing the burden of stroke is possible if effective preventive measures are provided. The possibilities of correcting lipid metabolism as an important measure aimed at preventing IS are analyzed.

[Proteomic technologies for identification of serum potential biomarkers of autoimmune demyelinating polyneuropathies].

Time-of-flight MALDI mass spectrometry (MALDI-TOF-MS) profiling of blood serum of patients with Guillain-Barré syndrome (GBS, 36 samples), chronic inflammatory demyelinating polyneuropathy (CIDP, 24 samples) and practically healthy donors (HD) (35 samples) was carried out in order to identify potential biomarkers of autoimmune demyelinating polyneuropathies (ADP). To simplify the peptide-protein mixture of serum prior to MALDI-TOF-MS analysis samples were pre-fractionated on magnetic microparticles with a weak cation-exchange (MB-WCX) surface. Comparative analysis of mass spectrometric data using the classification algorithms (genetic and neural network-controlled) revealed a characteristic set of peaks, agreed change area with a high specificity and sensitivity of the differentiated mass spectrometry profiles of the blood serum of patients with DPNP and healthy donors (for GBS values of these characteristics reached 100 and 100, and for CIDP 94.1 and 100% respectively). Comparative analysis of mass spectrometric profiles of serum samples obtained from patients with GBS and CIDP, allowed to build a classification model to differentiate these diseases from each other, with a specificity of 88.9 and a sensitivity of 80%.

[Validation of the Russian version of the Fugl-Meyer Assessment of Physical Performance for assessment of patients with post-stroke paresis]. / Validatsiya russkoyazychnoi versii shkaly Fugl-Meiera dlya otsenki sostoyaniya patsientov s postinsul'tnym parezom.

OBJECTIVE: To perform linguistic and cultural adaptation of the Fugl-Meyer Assessment of Physical Performance. MATERIALS AND METHODS: The study for assessment of psychometric properties included 53 post-stroke patients with neurological deficit presented by hemiparesis of different severity. The patients were assessed twice: at admission and after 14 days of treatment and rehabilitation procedures. The Russian version of the Fugl-Meyer Assessment of Physical Performance was developed with consideration of language and cultural characteristics. RESULTS AND CONCLUSION: Results of assessment of psychometric properties of the Russian-language version show its high validity, reliability and sensitivity. The developed Russian-language version of Fugl-Meyer Assessment of Physical Performance is recommended for using by neurologists and rehabilitation specialists both in everyday clinical practice and in clinical studies of patients with post-stroke paresis. The results obtained in the study show necessity for pre-training of specialists who perform assessment of patients with post-stroke paresis using the Fugl-Meyer Assessment of Physical Performance.

[Efficacy of cytoflavin in the treatment of chronic cerebral ischemia].

The author presents results of multicentre randomized studies of therapeutic efficiency of cytoflavin tablets in patients with chronic cerebral ischemia including asthenovegetative syndrome. Cytoflavin was shown to reduce clinical manifestations of asthenia, anxiety, depression, cognitive and emotional disorders and simultaneously improve quality of life. The efficiency of cytoflavin is confirmed by improved physical and psychic state of the patients, their enhanced social activity.

[Therapeutic efficiency of cytoflavine solution for infusion in emergency conditions].

The author reports results of clinical assessment of cytoflavin for injections in the treatment of different pathological condition including critical ones. It was shown that therapy reduces mortality among patients with acute disturbances of cerebral circulation to 4.8-9.6% compared with 11.7-17.1% in controls. Positive dynamic of neurologic status was documented in 79% of the patients with dyscirculatory encephalopathy versus 25% in control. Duration of comatose state decreased 1,7-fold, length of stay in resuscitation and intensive therapy wards 1.8-fold, and frequency of internal complications secondary to the effect of neurotropic poisons 2-fold. Cytoflavin corrected the level of metalloproteides and stabilized antioxidative potential of sera and cerebrospinal liquid in patient with meningitis including that of zoonotic etiology. In the period of post-narcosis rehabilitation cytoflavin restored conscience in 77% of the patients within 20 min. The drug also inhibited pathological alcohol addiction within 5 days after the onset of therapy as apparent from the improvement of intellectual-mnestic status and activization of attention. The frequency of infectious complications in patients with acute surgical abdominal pathology decreased by 5.1% and lethality by 3.6% compared with placebo group. Cytoflavin exhibited cardioprotective action in patients with myocardial infarction, during cardiosurgical intervention, and chronic brucellosis. It had hepatoprotective effect in iatrogenic hepatic conditions as well as ophthalmo- and oto-protective activity.

[Issues of diagnostic and therapeutic use of transcranial magnetic stimulation in patients with writing cramp]. / Voprosy diagnosticheskogo i terapevticheskogo primeneniya transkranial'noi magnitnoi stimulyatsii u patsientov s pischim spazmom.

OBJECTIVE: To study diagnostic and therapeutic values of transcranial magnetic stimulation (TMS) in writing cramp (WC). MATERIAL AND METHODS: Twelve right-handed patients with WC were enrolled in the study. All patients underwent low-frequency repetitive TMS (rTMS) of the premotor cortex of contralateral to affected hand hemisphere. The clinical efficacy was assessed using the Writer's Cramp Rating Scale (WCRS) and the Medical Outcomes Study-Short Form (MOS-SF-36). Before and after last rTMS session, motor mapping of Abductor pollicis brevis muscle (APB) was performed using navigated TMS (nTMS). Localization, area, and amplitude-weighted area of the APB muscle cortical representations were compared with the healthy controls. After the rTMS course, the dynamics of the studied parameters was assessed. RESULTS: Ten sessions of low-frequency rTMS of premotor cortex reduced the severity of WS clinical symptoms with a duration of effect of at least 1 month (p<0.05). There was no statistically significant difference between the area and the weighted area of cortical muscle representations between patients and healthy controls or in patients before and after rTMS. When assessing the localization of cortical muscle representations, two trends were noted: in 4 patients, the localization remained stable, with a shift in the center of gravity of less than 4 mm; in the other 8 patients, a shift in the center of mass of more than 5 mm was noted. No significant correlation between the stability of the cortical muscle representations (the magnitude of the shift in the center of gravity) and the improvement on the WCRS were found. CONCLUSION: The low-frequency rTMS of the premotor cortex of the contralateral to affected hand hemisphere can be used as an adjuvant therapy for WC. The TMS-motor mapping study did not show its diagnostic value.

[Influenza-associated acute necrotizing encephalitis in an adult]. / Ostryi nekroticheskii entsefalit, assotsiirovannyi s virusom grippa, u vzroslykh.

A rare case of acute necrotizing encephalitis associated with influenza virus in an adult man is described. This clinical case is one of the few published cases in the world literature and the only one in the Russian literature.

[Clinical and neurophysiological effects of dual-target high-frequency rTMS over the primary motor and prefrontal cortex in Parkinson's disease]. / Klinicheskie i neirofiziologicheskie effekty terapevticheskoi sochetannoi vysokochastotnoi ritmicheskoi transkranial'noi magnitnoi stimulyatsii motornoi i lobnoi kory pri bolezni Parkinsona.

OBJECTIVE: To evaluate therapeutic effects of navigational dual-target high-frequency rTMS over the primary motor (M1, bilateral) and the left dorsolateral prefrontal cortex (DLPFC) on clinical dynamics of Parkinson's disease (PD) symptoms in a parallel placebo-controlled study. MATERIAL AND METHODS: The study included 46 patients randomized into equal therapeutic and placebo rTMS groups. Navigational therapeutic and placebo10 Hz rTMS was applied over the M1 and DLPFC areas (20 daily sessions, for 3 weeks). Assessment of the dynamics of clinical symptoms was performed using the MDS UPDRS scale (Parts I-IV) before the first session, immediately after 20 sessions, and 4-6 weeks after the rTMS course. Non-motor and mental symptoms were assessed using the Hamilton Depression Rating Scale (HDRS-17), Beck depression inventory (BDI-II), Depression, Anxiety and Stress (DASS-21) scales and the Mini Mental State Examination (MMSE). RESULTS: Significant therapeutic effects of rTMS compared to placebo were established: a greater decrease in overall score on the MDS-UPDRS scale (parts I-IV), a decrease in the severity of non-motor (part I) and motor symptoms (part III, with a large therapeutic effect for the symptoms of rigidity, bradykinesia and postural instability), as well as the severity of motor complications of dopamine replacement therapy (part IV). The effects of rTMS on motor symptoms persisted 4 weeks after the end of the stimulation course. It is also important to note significant positive dynamics in both rTMS and placebo groups in the form of comparable reduction in the severity of everyday motor symptoms (MDS-UPDRS part II), improvement of the total scores on MMSE, HDRS, BDI-II, DASS-21. CONCLUSIONS: The dual-target high-frequency rTMS over the primary motor cortex (bilateral) and the left dorsolateral prefrontal cortex has positive therapeutic effects on the motor and affective symptoms of Parkinson's disease, which are significantly stronger than that of the placebo stimulation.

[Aminothiols in blood plasma at different subtypes of ischemic stroke]. / Aminotioly plazmy krovi pri razlichnykh podtipakh ishemicheskogo insul'ta.

OBJECTIVE: To evaluate the hemostasis of plasma aminothiols in different subtypes of ischemic stroke (IS). MATERIAL AND METHODS: The study included 177 patients, aged 62 (55-68) years, admitted in the first 8-24 hours since IS onset. The pathogenetic subtype of IS was clarified according to the results of clinical and instrumental examination by the Trial of ORG 10172 in Acute Stroke Treatment criteria. Determination of the total plasma aminothiols levels, their reduced forms and redox status was performed using the ultra-efficient Acquity H-Class UPLC liquid chromatograph (Waters, CSHA). RESULTS: Large-artery atherosclerosis was diagnosed in 24.3% patients, cardioembolic stroke in 20.3%, lacunar stroke in 55.4%. Significant differences in total levels of cysteine (Cys), glutathione (Gsh) and homocysteine (Hcy) were identified in patients with different IS subtypes. Patients with large-artery atherosclerosis and lacunar stroke showed the highest level of Hcy, patients with cardioembolic stroke had the lowest levels of Cys and Gsh. CONCLUSION: Total levels of plasma aminothiols are associated with different subtypes of IS.

[Diagnostic and therapeutic issues of using transcranial magnetic stimulation in patients with writer's cramp]. / Voprosy diagnosticheskogo i terapevticheskogo primeneniia transkranial'noi magnitnoi stimuliatsii u patsientov s pischim spazmom.

AIM: To assess diagnostic and therapeutic values of transcranial magnetic stimulation (TMS) in patients with writer's cramp (WC). MATERIAL AND METHODS: Twelve right-handed patients with WC were enrolled in the study. All patients underwent low-frequency repetitive TMS (rTMS) over the premotor cortex of the hemisphere contralateral to the affected hand. The clinical efficacy was assessed using the Writer's Cramp Rating Scale (WCRS) and the Medical Outcomes Study-Short Form (MOS-SF-36). Before and after the last rTMS session, motor mapping of abductor pollicis brevis muscle (APB) was performed using navigated TMS (nTMS). Localization, area, and amplitude-weighted area of the APB muscle cortical representations were compared with the healthy controls. The dynamics of the mentioned above parameters after the rTMS course was assessed. RESULTS: Ten sessions of low-frequency rTMS over premotor cortex reduced the severity of WC clinical symptoms, with a duration of effect of at least 1 month (p<0.05). There was no significant difference between the area and the weighted area of cortical muscle representations between patients and healthy controls or in patients before and after rTMS. When assessing the localization of cortical muscle representations, two trends were noted: in 4 patients, the localization remained stable, with a shift in the center of gravity of less than 4 mm; in the other 8 patients, a shift in the center of gravity of more than 5 mm was noted. No significant correlations between the stability of the cortical muscle representations (the magnitude of the shift in the center of gravity) and the improvement on the WCRS scale were found. CONCLUSION: The low-frequency rTMS over the premotor cortex of the hemisphere contralateral to the affected hand can be used as an adjuvant therapy for WC. The TMS-motor mapping study did not show its diagnostic value.