The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study

Abstract

Objectives: Transcranial magnetic stimulation, in particular continuous theta burst (cTBS), has been proposed for stroke rehabilitation, based on the concept that inhibition of the healthy hemisphere helps promote the recovery of the lesioned one. We aimed to study its effects on cortical excitability, oscillatory patterns, and motor function, the main aim being to identify potentially beneficial neurophysiological effects.Materials and Methods: We applied randomized real or placebo stimulation over the unaffected primary motor cortex of 10 subacute (7 ± 3 days) post-stroke patients. Neurophysiological measurements were performed using electroencephalography and electromyography. Motor function was assessed with the Wolf Motor Function Test. We performed a repeated measure study with the recordings taken pre-, post-cTBS, and at 3 months' follow-up.Results: We investigated changes in motor rhythms during arm elevation and thumb opposition tasks and found significant changes in beta power of the affected thumb's opposition, specifically after real cTBS. Our results are consistent with an excitatory response (increase in event-related desynchronization) in the sensorimotor cortical areas of the affected hemisphere, after stimulation. Neither peak-to-peak amplitude of motor-evoked potentials nor motor performance were significantly altered.Conclusions: Consistently with the theoretical prediction, this contralateral inhibitory stimulation paradigm changes neurophysiology, leading to a significant excitatory impact on the cortical oscillatory patterns of the contralateral hemisphere. These proof-of-concept results provide evidence for the potential role of continuous TBS in the neurorehabilitation of post-stroke patients. We suggest that these changes in ERS/ERD patterns should be further explored in future phase IIb/phase III clinical trials, in larger samples of poststroke patients.

The role of brain oscillations in post-stroke motor recovery: An overview

“…Four out of thirteen articles investigated upper limb functions through transcranial stimulation (Nicolo et al, 2018;Ding et al, 2021;Dionísio et al, 2021;Kuzu et al, 2021). Dionísio et al (2021) compared cTBS vs. placebo stimulation, finding that contralateral inhibitory stimulation led to a significant excitatory impact on the cortical oscillatory beta band patterns of the contralateral affected hemisphere.…”

“…Four out of thirteen articles investigated upper limb functions through transcranial stimulation (Nicolo et al, 2018;Ding et al, 2021;Dionísio et al, 2021;Kuzu et al, 2021). Dionísio et al (2021) compared cTBS vs. placebo stimulation, finding that contralateral inhibitory stimulation led to a significant excitatory impact on the cortical oscillatory beta band patterns of the contralateral affected hemisphere. In Ding's (2021) study, the authors found that iTBS modulates brain network functioning in stroke survivors, normalizing brain connections, re-gaining the natural oscillation frequency, and promoting motor function recovery.…”

The Role of Continuous Theta Burst Stimulation on Primary Motor Cortex in Improving Bladder Function in Post-stroke Patients: A Case Report

“…It is pleasing to observe the notable success of our intervention in augmenting bladder function, kidney function, and overall quality of life, as well as mitigating symptoms of anxiety and depression among the patients. According to Dionísio et al, when cTBS is applied over the contralesional primary motor cortex of subacute post-stroke patients (within 7 ± 3 days), it results in an increase in cortical excitability and motor function in the ipsilesional hemisphere [17]. As a result, the patient's muscle strength and balance showed improvement, although it is important to note that this outcome can be attributed to a combination of conventional physical therapy and cTBS.…”

Current evidence, clinical applications, and future directions of transcranial magnetic stimulation as a treatment for ischemic stroke

“…TMS has been reported to have neuroprotective effects in a variety of neurological disorders, such as Alzheimer’s disease ( Mimura et al, 2021 ), Parkinson’s ( Chen and Chen, 2019 ), multiple sclerosis ( Aloizou et al, 2021 ), depression ( Toth et al, 2022 ), vascular dementia ( Nardone et al, 2011 ), and stroke ( Tosun et al, 2017 ). Some studies have shown that TMS combined with a variety of rehabilitation treatments can significantly reduce neurological dysfunction, improve the ability to perform activities of daily living, and improve the quality of life of stroke patients ( Dionísio et al, 2021 ; Hoonhorst et al, 2021 ; Zong et al, 2022 ). This suggests that TMS is a feasible adjunctive treatment for stroke.…”