The Effect of Sham Controlled Continuous Theta Burst Stimulation and Low Frequency Repetitive Transcranial Magnetic Stimulation on Upper Extremity Spasticity and Functional Recovery in Chronic Ischemic Stroke Patients

Kuzu, Ömer; Adıgüzel, Emre; Kesikburun, Serdar; Yaşar, Evren; Yılmaz, Bilge

doi:10.1016/j.jstrokecerebrovasdis.2021.105795

Cited by 26 publications

(29 citation statements)

References 34 publications

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“…Despite receiving intensive rehabilitative therapies, many patients post-stroke retained motor dysfunction at variable degrees (3)(4)(5), which decreased health-related quality of life (6). Recently, many studies have suggested that repetitive transcranial magnetic stimulation (rTMS) may be a promising therapy for promoting recovery of the upper limb after stroke (7)(8)(9)(10), possibly through modulating cortical excitability and inducing neural plasticity (11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Excitatory Repetitive Transcranial Magnetic Stimulation Over the Ipsilesional Hemisphere for Upper Limb Motor Function After Stroke: A Systematic Review and Meta-Analysis

et al. 2022

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BackgroundRepetitive transcranial magnetic stimulation (rTMS) is a promising therapy to promote recovery of the upper limb after stroke. According to the regulation of cortical excitability, rTMS can be divided into excitatory rTMS and inhibitory rTMS, and excitatory rTMS includes high-frequency rTMS (HF-rTMS) or intermittent theta-burst stimulation (iTBS). We aimed to evaluate the effects of excitatory rTMS over the ipsilesional hemisphere on upper limb motor recovery after stroke.MethodsDatabases of PubMed, Embase, ISI Web of Science, and the Cochrane Library were searched for randomized controlled trials published before 31 December 2021. RCTs on the effects of HF-rTMS or iTBS on upper limb function in patients diagnosed with stroke were included. Two researchers independently screened the literature, extracted the data, and assessed quality. The meta-analysis was performed by using Review Manager Version 5.4 software.ResultsFifteen studies with 449 participants were included in this meta-analysis. This meta-analysis found that excitatory rTMS had significant efficacy on upper limb motor function (MD = 5.88, 95% CI, 3.32–8.43, P < 0.001), hand strength (SMD = 0.53, 95% CI, 0.04–1.01, P = 0.03), and hand dexterity (SMD = 0.76, 95% CI, 0.39–1.14, P < 0.001). Subgroup analyses based on different types of rTMS showed that both iTBS and HF-rTMS significantly promoted upper limb motor function (iTBS, P < 0.001; HF-rTMS, P < 0.001) and hand dexterity (iTBS, P = 0.01; HF-rTMS, P < 0.001) but not hand strength (iTBS, P = 0.07; HF-rTMS, P = 0.12). Further subgroup analysis based on the duration of illness demonstrated that applying excitatory rTMS during the first 3 months (<1 month, P = 0.01; 1–3 months, P = 0.001) after stroke brought significant improvement in upper limb motor function but not in the patients with a duration longer than 3 months (P = 0.06). We found that HF-rTMS significantly enhanced the motor evoked potential (MEP) amplitude of affected hemisphere (SMD = 0.82, 95% CI, 0.32–1.33, P = 0.001).ConclusionOur study demonstrated that excitatory rTMS over the ipsilesional hemisphere could significantly improve upper limb motor function, hand strength, and hand dexterity in patients diagnosed with stroke. Both iTBS and HF-rTMS which could significantly promote upper limb motor function and hand dexterity, and excitatory rTMS were beneficial to upper limb motor function recovery only when applied in the first 3 months after stroke. HF-rTMS could significantly enhance the MEP amplitude of the affected hemisphere. High-quality and large-scale randomized controlled trials in the future are required to confirm our conclusions.Clinical Trial Registrationwww.crd.york.ac.uk/prospero/, identifier: CRD42022312288.

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Section: Introductionmentioning

confidence: 99%

Excitatory Repetitive Transcranial Magnetic Stimulation Over the Ipsilesional Hemisphere for Upper Limb Motor Function After Stroke: A Systematic Review and Meta-Analysis

et al. 2022

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“…Through the final full-text review, 14 articles were ultimately included for this review. This study included eight research articles [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] on rTMS, one of which included three data sets, one article included two data sets and the other articles each had one data set. A total of 128 patients received rTMS in all studies, and 104 patients served as the control group.…”

Section: Resultsmentioning

confidence: 99%

“…In this meta-analysis, three of the included articles [ 26 , 28 , 31 ] designed different experimental groups based on the stimulation method. There was no mutual interference between the different experimental groups, so each study was treated as an RCT.…”

Section: Resultsmentioning

confidence: 99%

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

Wang

Liu

et al. 2022

Brain Sciences

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In recent years, the potential of non-invasive brain stimulation (NIBS) for the therapeutic effect of post-stroke spasticity has been explored. There are various NIBS methods depending on the stimulation modality, site and parameters. The purpose of this study is to evaluate the efficacy of NIBS on spasticity in patients after stroke. This systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. PUBMED (MEDLINE), Web of Science, Cochrane Library and Excerpta Medica Database (EMBASE) were searched for all randomized controlled trials (RCTs) published before December 2021. Two independent researchers screened relevant articles and extracted data. This meta-analysis included 14 articles, and all included articles included 18 RCT datasets. The results showed that repetitive transcranial magnetic stimulation (rTMS) (MD = −0.40, [95% CI]: −0.56 to −0.25, p < 0.01) had a significant effect on improving spasticity, in which low-frequency rTMS (LF-rTMS) (MD = −0.51, [95% CI]: −0.78 to −0.24, p < 0.01) and stimulation of the unaffected hemisphere (MD = −0.58, [95% CI]: −0.80 to −0.36, p < 0.01) were beneficial on Modified Ashworth Scale (MAS) in patients with post-stroke spasticity. Transcranial direct current stimulation (tDCS) (MD = −0.65, [95% CI]: −1.07 to −0.22, p < 0.01) also had a significant impact on post-stroke rehabilitation, with anodal stimulation (MD = −0.74, [95% CI]: −1.35 to −0.13, p < 0.05) being more effective in improving spasticity in patients. This meta-analysis revealed moderate evidence that NIBS reduces spasticity after stroke and may promote recovery in stroke survivors. Future studies investigating the mechanisms of NIBS in addressing spasticity are warranted to further support the clinical application of NIBS in post-stroke spasticity.

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“…Low-frequency stimulation may also be of use beyond the scope of epilepsy, and could hold therapeutic potential for a wide spectrum of diseases with altered states of network excitability; these include pain conditions ( Di Lazzaro et al, 2008 ), spasticity ( Kuzu et al, 2021 ), extrapyramidal motor disorders ( Vallabhajosula et al, 2015 ), sleep disorders ( Hathaway et al, 2021 ) and craving ( Liu et al, 2017 ). A better understanding of the underlying neurophysiology as well as the affected aspects of synchronization could further contribute to its targeted application.…”

Section: Discussionmentioning

confidence: 99%

Low-frequency electrical stimulation reduces cortical excitability in the human brain

Manzouri

Meisel

Kunz

et al. 2021

NeuroImage: Clinical

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Highlights 1 Hz electrical stimulation reduces post-stimulation cortical phase synchronization levels which is an indirect measure of cortical excitability. Phase synchronization reduction is observed across alpha, beta, gamma, and high-gamma (105–195 Hz) frequency bands by 1 Hz stimulation. Reduction of the phase synchronization levels due to 1 Hz electrical stimulation is significant in patients with stimulation sites in neocortex. Reduction of the phase synchronization levels caused by 1 Hz electrical stimulation is widespread, yet more prominent in the stimulated hemisphere.

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The Effect of Sham Controlled Continuous Theta Burst Stimulation and Low Frequency Repetitive Transcranial Magnetic Stimulation on Upper Extremity Spasticity and Functional Recovery in Chronic Ischemic Stroke Patients

Cited by 26 publications

References 34 publications

Excitatory Repetitive Transcranial Magnetic Stimulation Over the Ipsilesional Hemisphere for Upper Limb Motor Function After Stroke: A Systematic Review and Meta-Analysis

Excitatory Repetitive Transcranial Magnetic Stimulation Over the Ipsilesional Hemisphere for Upper Limb Motor Function After Stroke: A Systematic Review and Meta-Analysis

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

Low-frequency electrical stimulation reduces cortical excitability in the human brain

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