Efficacy and Safety of High-Dose TBS on Poststroke Upper Extremity Motor Impairment: A Randomized Controlled Trial

Zhiqing Tang; Jianting Huang; Ying Zhou; Jianxun Ren; Xinyu Duan; Xiaoxuan Fu; Ruiqi Pan; Rongrong Wang; Ping Zhang; Mengying Ding; Jian Sun; Xiaonian Zhang; Qianqian Chi; Yue Zhang; Xin Zhang; Weiyong Yu; Liu Xu; Hao Zhang; Hesheng Liu

doi:10.1161/STROKEAHA.124.046597

Efficacy and Safety of High-Dose TBS on Poststroke Upper Extremity Motor Impairment: A Randomized Controlled Trial

Stroke. 2024 Sep;55(9):2212-2220. doi: 10.1161/STROKEAHA.124.046597. Epub 2024 Jul 17.

Authors

Zhiqing Tang^#^{1

2}, Jianting Huang^#^{3

4

5}, Ying Zhou^#³, Jianxun Ren³, Xinyu Duan³, Xiaoxuan Fu³, Ruiqi Pan⁶, Rongrong Wang^{1

2}, Ping Zhang³, Mengying Ding⁶, Jian Sun⁶, Xiaonian Zhang^{1

2}, Qianqian Chi^{1

2}, Yue Zhang^{1

2}, Xin Zhang^{1

2}, Weiyong Yu^{1

7}, Liu Xu⁸, Hao Zhang^{1

2

9

10}, Hesheng Liu^{3

11}

Affiliations

¹ School of Rehabilitation, Capital Medical University, Beijing, China (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, W.Y., H.Z.).
² Department of Neurorehabilitation (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, H.Z.), Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing.
³ Changping Laboratory, Beijing, China (J.H., Y. Zhou, J.R., X.D., X.F., P.Z., H.L.).
⁴ Academy for Advanced Interdisciplinary Studies (J.H.), Peking University, Beijing, China.
⁵ Chinese Institute for Brain Research, Beijing, China (J.H.).
⁶ Neural Galaxy, Inc, Beijing, China (R.P., M.D., J.S.).
⁷ Department of Radiology (W.Y.), Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing.
⁸ West China Medical School, Sichuan University, Chengdu (L.X.).
⁹ University of Health and Rehabilitation Sciences, Qingdao, China (H.Z.).
¹⁰ Cheeloo College of Medicine, Shandong University, Jinan, China (H.Z.).
¹¹ Biomedical Pioneering Innovation Center (H.L.), Peking University, Beijing, China.

^# Contributed equally.

Abstract

Background: Upper extremity (UE) motor function impairment is a major poststroke complication whose recovery remains one of the most challenging tasks in neurological rehabilitation. This study examined the efficacy and safety of the personalized neuroimaging-guided high-dose theta-burst stimulation (TBS) for poststroke UE motor function recovery.

Methods: Patients after stroke with UE motor impairment from a China rehabilitation center were randomly assigned to receive high-dose intermittent TBS (iTBS) to ipsilesional UE sensorimotor network, continuous TBS (cTBS) to contralesional UE sensorimotor network, or sham stimulation, along with conventional therapy for 3 weeks. The primary outcome was the score changes on the Fugl-Meyer assessment-UE from baseline to 1 and 3 weeks. The secondary outcomes included the response rate on Fugl-Meyer assessment-UE scores posttreatment (≥9-point improvement) and score changes in multidimensional scales measuring UE, lower extremity, and activities and participation.

Results: From June 2021 to June 2022, 45 participants were randomized and 43 were analyzed. The iTBS and continuous TBS groups showed significantly greater improvement in Fugl-Meyer assessment-UE (mean improvement, iTBS: 10.73 points; continuous TBS: 10.79 points) than the sham group (2.43 points) and exhibited significantly greater response rates on Fugl-Meyer assessment-UE (iTBS, 60.0%; continuous TBS, 64.3%) than the sham group (0.0%). The active groups consistently exhibited superior improvement on the other 2 UE assessments at week 3. However, only the iTBS group showed greater efficacy on 1 lower extremity assessment than the sham group at week 3. Both active groups showed significant improvements in activities and participation assessments.

Conclusions: The study provides evidence for the efficacy and safety of high-dose TBS in facilitating poststroke UE rehabilitation.

Registration: URL: www.chictr.org.cn; Unique identifier: ChiCTR2100047340.

Keywords: magnetic resonance imaging; neurological rehabilitation; stroke; transcranial magnetic stimulation; upper extremity.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Female
Humans
Male
Middle Aged
Recovery of Function* / physiology
Stroke Rehabilitation* / methods
Stroke* / complications
Stroke* / physiopathology
Transcranial Magnetic Stimulation* / methods
Treatment Outcome
Upper Extremity* / physiopathology

Associated data

ChiCTR/ChiCTR2100047340