High-Dose TBS Linked to Improved Poststroke Motor Function

TOPLINE:

High-dose theta burst stimulation (TBS) is associated with significantly improved poststroke upper extremity (UE) motor function. Both intermittent TBS (iTBS) and continuous TBS (cTBS) groups showed greater improvements than those receiving sham stimulation.

METHODOLOGY:

• Participants were recruited from the Inpatient Department at the China Rehabilitation Research Center in Beijing, China. Participants were patients with first-time stroke at least 1-month post-onset, 18-70 years old, and with unilateral limb motor impairment.
• Participants were randomly assigned to receive either iTBS (n = 15) to the ipsilesional upper extremity sensorimotor network (UESN), cTBS (n = 15) to the contralesional UESN, or sham TBS (n = 15). The treatment lasted 3 weeks, with 5 consecutive weekdays each week, during which all patients received the allocated stimulation and conventional motor rehabilitation programs.
• Participants, clinical assessors, behavioral therapists, data analysts, and other research staff were all blinded to the assignment.
• There were a number of neuropsychological assessments conducted at baseline (TO) and after 1 (T1) and 3 (T2) weeks of intervention.

TAKEAWAY:

• Significantly more participants in the iTBS and cTBS groups showed clinically significant responses as indicated by the minimal clinically important difference in the Fugl-Meyer assessment-upper extremity than those in the sham group (iTBS, 60.0%; cTBS, 64.3%; sham, 0.0%; P < .001).
• Post hoc analyses revealed a significantly greater effect in the iTBS group than in the sham group at T2 (P < .001).
• A superior effect of cTBS compared with sham was found at both T1 (P = .008) and T2 (P < .001).
• A subgroup comparison showed a significant difference between the cTBS and the sham group (P = .018), suggesting a greater treatment efficacy of cTBS.

IN PRACTICE:

“Overall, high-dose TBS emerges as a safe, effective, and efficient treatment modality for poststroke UE motor impairment in clinical settings. This therapeutic protocol exhibits good tolerability among patients with stroke, characterized by mild and infrequent adverse effects,” wrote the authors of the study.

SOURCE:

Zhiqing Tang, MD, of Capital Medical University, Beijing, China, led the study, which was published online on July 17 in Stroke.

LIMITATIONS:

The authors noted that the small sample size and single-center study design may limit generalizability. In addition, the timing of conventional therapy relative to TBS sessions was not strictly structured due to clinical feasibility, which may affect treatment efficacy interpretation. Finally, the upper age limit may have excluded a considerable portion of the stroke population, especially because stroke onset generally occurs later in life, and even more so in women.

DISCLOSURES:

The study was supported by grants from the Changping Laboratory and China Postdoctoral Science Foundation. Disclosures are noted in the original study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.