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

Huang, Wenhao; Chen, Jiayi; Zheng, Yongping; Zhang, Jin; Li, Xin; Su, Liujie; Li, Yinying; Dou, Zulin

doi:10.3389/fneur.2022.896651

Cited by 9 publications

(5 citation statements)

References 34 publications

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“…Besides, standard 600-pulse stimulation showed a better effect on motor function improvement compared to 1200 pulses. The results are consistent with previous studies [ 16 , 52 , 53 ]. Additionally, two studies [ 34 ] integrated different forms of rTMS and reported that bi-hemispheric stimulation (1 Hz rTMS to the UH M1 and iTBS to the AH M1) was associated with better motor performance when compared to unilateral modulation [ 54 ].…”

Section: Discussionsupporting

confidence: 94%

Theta burst stimulation: what role does it play in stroke rehabilitation? A systematic review of the existing evidence

Jiang,

Wei,

Wang

et al. 2024

BMC Neurol

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Various post-stroke dysfunctions often result in poor long-term outcomes for stroke survivors, but the effect of conventional treatments is limited. In recent years, lots of studies have confirmed the effect of repetitive transcranial magnetic stimulation (rTMS) in stroke rehabilitation. As a new pattern of rTMS, theta burst stimulation (TBS) was proved recently to yield more pronounced and long-lasting after-effects than the conventional pattern at a shorter stimulation duration. To explore the role of TBS in stroke rehabilitation, this review summarizes the existing evidence from all the randomized controlled trials (RCTs) so far on the efficacy of TBS applied to different post-stroke dysfunctions, including cognitive impairment, visuospatial neglect, aphasia, dysphagia, spasticity, and motor dysfunction. Overall, TBS promotes the progress of stroke rehabilitation and may serve as a preferable alternative to traditional rTMS. However, it’s hard to recommend a specific paradigm of TBS due to the limited number of current studies and their heterogeneity. Further high-quality clinical RCTs are needed to determine the optimal technical settings and intervention time in stroke survivors.

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Section: Discussionsupporting

confidence: 94%

Theta burst stimulation: what role does it play in stroke rehabilitation? A systematic review of the existing evidence

Jiang,

Wei,

Wang

et al. 2024

BMC Neurol

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“…According to the baseline neurophysiological characteristics of healthy participants before intervention, the Extra Trees model accurately classified responders to TBS. Interventions for post-stroke motor dysfunction in the upper and lower limbs using TBS are currently based on interhemispheric competition models ( Chieffo et al, 2016 ; Huang et al, 2022 ; Vink et al, 2023 ). In the future, these models may improve post-stroke paralysis by customizing iTBS and cTBS to an individual’s responsiveness.…”

Section: Discussionmentioning

confidence: 99%

Predicting interindividual response to theta burst stimulation in the lower limb motor cortex using machine learning

Katagiri,

Saho,

Shibukawa

et al. 2024

Front. Neurosci.

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Using theta burst stimulation (TBS) to induce neural plasticity has played an important role in improving the treatment of neurological disorders. However, the variability of TBS-induced synaptic plasticity in the primary motor cortex prevents its clinical application. Thus, factors associated with this variability should be explored to enable the creation of a predictive model. Statistical approaches, such as regression analysis, have been used to predict the effects of TBS. Machine learning may potentially uncover previously unexplored predictive factors due to its increased capacity for capturing nonlinear changes. In this study, we used our prior dataset (Katagiri et al., 2020) to determine the factors that predict variability in TBS-induced synaptic plasticity in the lower limb motor cortex for both intermittent (iTBS) and continuous (cTBS) TBS using machine learning. Validation of the created model showed an area under the curve (AUC) of 0.85 and 0.69 and positive predictive values of 77.7 and 70.0% for iTBS and cTBS, respectively; the negative predictive value was 75.5% for both patterns. Additionally, the accuracy was 0.76 and 0.72, precision was 0.82 and 0.67, recall was 0.82 and 0.67, and F1 scores were 0.82 and 0.67 for iTBS and cTBS, respectively. The most important predictor of iTBS was the motor evoked potential amplitude, whereas it was the intracortical facilitation for cTBS. Our results provide additional insights into the prediction of the effects of TBS variability according to baseline neurophysiological factors.

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“…Figure 3 presents the details of all the stimulation protocols. Traditional tDCS and Theta Burst Stimulation (TBS) protocols are widely used neuromodulation approaches for various neurological disorders ( Bologna et al, 2015 ; Bornheim et al, 2022 ; Huang W. et al, 2022 ; Zhang et al, 2022 ). For example, anodal tDCS increases neuronal excitability, producing long-term potentiation (LTP)-like effects, while cathodal tDCS induces long-term depression (LTD)-like effects ( Rroji et al, 2015 ; Kronberg et al, 2017 ).…”

Section: Methodsmentioning

confidence: 99%

Transcranial burst electrical stimulation contributes to neuromodulatory effects in the rat motor cortex

Nguyen,

Kuo,

Peng

et al. 2023

Front. Neurosci.

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Background and objectiveTranscranial Burst Electrical Stimulation (tBES) is an innovative non-invasive brain stimulation technique that combines direct current (DC) and theta burst stimulation (TBS) for brain neuromodulation. It has been suggested that the tBES protocol may efficiently induce neuroplasticity. However, few studies have systematically tested neuromodulatory effects and underlying neurophysiological mechanisms by manipulating the polarity of DC and TBS patterns. This study aimed to develop the platform and assess neuromodulatory effects and neuronal activity changes following tBES.MethodsFive groups of rats were exposed to anodal DC combined with intermittent TBS (tBES+), cathodal DC combined with continuous TBS (tBES−), anodal and cathodal transcranial direct current stimulation (tDCS+ and tDCS−), and sham groups. The neuromodulatory effects of each stimulation on motor cortical excitability were analyzed by motor-evoked potentials (MEPs) changes. We also investigated the effects of tBES on both excitatory and inhibitory neural biomarkers. We specifically examined c-Fos and glutamic acid decarboxylase (GAD-65) using immunohistochemistry staining techniques. Additionally, we evaluated the safety of tBES by analyzing glial fibrillary acidic protein (GFAP) expression.ResultsOur findings demonstrated significant impacts of tBES on motor cortical excitability up to 30 min post-stimulation. Specifically, MEPs significantly increased after tBES (+) compared to pre-stimulation (p = 0.026) and sham condition (p = 0.025). Conversely, tBES (−) led to a notable decrease in MEPs relative to baseline (p = 0.04) and sham condition (p = 0.048). Although tBES showed a more favorable neuromodulatory effect than tDCS, statistical analysis revealed no significant differences between these two groups (p > 0.05). Additionally, tBES (+) exhibited a significant activation of excitatory neurons, indicated by increased c-Fos expression (p < 0.05), and a reduction in GAD-65 density (p < 0.05). tBES (−) promoted GAD-65 expression (p < 0.05) while inhibiting c-Fos activation (p < 0.05), suggesting the involvement of cortical inhibition with tBES (−). The expression of GFAP showed no significant difference between tBES and sham conditions (p > 0.05), indicating that tBES did not induce neural injury in the stimulated regions.ConclusionOur study indicates that tBES effectively modulates motor cortical excitability. This research significantly contributes to a better understanding of the neuromodulatory effects of tBES, and could provide valuable evidence for its potential clinical applications in treating neurological disorders.

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

Cited by 9 publications

References 34 publications

Theta burst stimulation: what role does it play in stroke rehabilitation? A systematic review of the existing evidence

Theta burst stimulation: what role does it play in stroke rehabilitation? A systematic review of the existing evidence

Predicting interindividual response to theta burst stimulation in the lower limb motor cortex using machine learning

Transcranial burst electrical stimulation contributes to neuromodulatory effects in the rat motor cortex

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