Cerebellar Intermittent Theta-Burst Stimulation Reduces Upper Limb Spasticity After Subacute Stroke: A Randomized Controlled Trial

Abstract

Objective: This study aims to explore the efficacy of cerebellar intermittent theta-burst stimulation (iTBS) on upper limb spasticity in subacute stroke patients.Methods: A total of 32 patients with upper limb spasticity were enrolled and randomly assigned to treatment with cerebellar iTBS or sham stimulation before conventional physical therapy daily for 2 weeks. The primary outcomes included the modified Ashworth scale (MAS), the modified Tardieu scale (MTS), and the shear wave velocity (SWV). The secondary outcomes were the H-maximum wave/M-maximum wave amplitude ratio (Hmax/Mmax ratio), motor-evoked potential (MEP) latency and amplitude, central motor conduction time (CMCT), and the Barthel Index (BI). All outcomes were evaluated at baseline and after 10 sessions of intervention.Results: After the intervention, both groups showed significant improvements in the MAS, MTS, SWV, and BI. In addition, patients treated with cerebellar iTBS had a significant increase in MEP amplitude, and patients treated with sham stimulation had a significant decrease in Hmax/Mmax ratio. Compared with the sham stimulation group, the MAS, MTS, and SWV decreased more in the cerebellar iTBS group.Conclusion: Cerebellar iTBS is a promising adjuvant tool to reinforce the therapeutic effect of conventional physical therapy in upper limb spasticity management after subacute stroke (Chinese Clinical Trial Registry: ChiCTR1900026516).

The Effectiveness of Intermittent Theta Burst Stimulation for Stroke Patients With Upper Limb Impairments: A Systematic Review and Meta-Analysis

“…Random sequence generation or allocation concealment scored a high risk of bias or unclear risk in four of the included studies, which led to the error of the result to increase ( 15 , 21 , 23 , 25 ). Blinding of participants and personnel scored unclear risk in some of the included studies, which was inherent to the intervention ( 15 , 17 , 18 , 23 , 26 – 28 , 30 – 32 ). According to certain studies, the blinding of outcome assessment was not specified adequately, resulting in a score that was unclear or high in the detection bias ( 22 , 23 , 25 , 28 , 30 , 32 ).…”

“…More research is required in the future to corroborate this conclusion. According to the included studies, it was widely believed that iTBS delivered a 2-s train of bursts consisting of three 50-Hz pulses repeated every 200 ms (5 Hz) at an intensity of 70–80% AMT or RMT every 10 s for 20 times (600 pulses total), which was the most beneficial plan ( 15 , 16 , 18 , 21 , 23 , 26 , 27 , 30 ). At the same time, the majority of studies had positive benefits after 2 weeks or 10 sessions, which warrants further investigation ( 15 , 17 – 19 , 21 – 28 , 31 , 32 ).…”

“…In addition, when different sites are stimulated, it can improve motor function by activating different pathways. The use of iTBS to stimulate the cerebellum has been shown to improve visual–motor integration, which has been shown to improve upper limb function in the stroke patients ( 18 ).…”

Targeting Cerebellum with Non-Invasive Transcranial Magnetic or Current Stimulation after Cerebral Hemispheric Stroke—Insights for Corticocerebellar Network Reorganization: A Comprehensive Review

“…A significant decrease in the modified Ashworth scale (MAS), the modified Tardieu scale (MTS), and upper limb elastography values were noted in the iTBS group compared to sham, leading to the conclusion that ipsilesional cerebellar iTBS can reinforce physical therapy gains in upper limp poststroke spasticity. The possible mechanisms include, according to the authors, the induced plasticity in Purkinje-cell level, as well as the influence on spinal neurons responsible for muscle tone adjustments [ 44 ]. Clinical studies concerning cerebellar TMS applications in stroke rehabilitation are presented in Table 1 .…”

Effects of Non-Invasive Brain Stimulation on Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…In patients after stroke, the balance between the two hemispheres of the brain is disrupted, resulting in hyperexcitability of the unaffected hemisphere and increased inhibition of the affected hemisphere [ 46 ]. Most of the reported findings showed that LF-rTMS had a positive effect on post-stroke spasticity [ 47 , 48 , 49 ].…”