Hypothesis: Low frequency repetitive trans cranial magnetic stimulation onto the contralesional primary motor cortex along with physical therapy in subacute ischemic stroke patients will enhance serum VEGF and BDNF levels
Methods: Participants with first ever ischemic stroke (n=96) in the previous 15 days were randomized after a run-in period of 75+/- 7 days with standard physical therapy to receive 10 sessions of real low frequency (1 Hz, 750 pulses, inter train stimulus interval~45 seconds, 110% resting motor threshold) rTMS (n=47) on contralesional primary motor cortex or to sham stimulation (n=49) over a duration of 2 weeks. Non fasting venous blood samples were collected at baseline, pre-rTMS and post-rTMS for serum VEGF and BDNF estimation.
Results: There was significant increase in the mean VEGF(673.04 ±193.28 pg/ml vs 797.24 ± 224.27 pg/ml ; p<0.001and BDNF(25.12 ±10.11 ng/ml vs 30.64 ± 9.64 ng/ml; p<0.001) at post rTMS was seen in the Real rTMS group compared to the Sham rTMS group
Conclusion:  Both VEGF and BDNF levels were significantly elevated in patients receiving low frequency rTMS in combination with physical therapy compared to those receiving only conventional physical therapy. Both these growth factors may have significant role in the pathophysiology of stroke recovery mediated by rTMS.

ROLE OF SERUM GROWTH FACTORS (VASCULAR ENDOTHELIAL GROWTH FACTOR AND BRAIN-DERIVED NEUROTROPHIC FACTOR ) IN REPETITIVE TRANS CRANIAL MAGNETIC STIMULATION ASSISTED RECOVERY IN SUBACUTE STROKE