Functional Near-Infrared Spectroscopy as a Target Navigator for rTMS Modulation in Patients with Hemiplegia: A Randomized Control Study

Pang-Wei Chang, Chia-Feng Lu, Shin-Tsu Chang, Po-Yi Tsai, Pang-Wei Chang, Chia-Feng Lu, Shin-Tsu Chang, Po-Yi Tsai

Abstract

Introduction: Although repetitive transcranial magnetic stimulation (rTMS) is efficacious for motor neuromodulation in stroke survivors, high interindividual variability for responsiveness remains a concern. Target probing on the skull using a proper brain-mapping technique may help overcome this challenge. This study assessed the feasibility of functional near-infrared spectroscopy (fNIRS) as a target navigator in rTMS treatment for motor facilitation in patients with stroke.

Methods: Fifty-one patients with stroke were enrolled in this randomized controlled study. The patients were assigned to three groups: fNIRS-guided rTMS treatment (fNIRS group, n = 20), motor evoked potential (MEP)-guided rTMS treatment (MEP group, n = 16), and sham (n = 15) group. Motor assessments, including Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), and muscle strength, were conducted at baseline and after the 10-session rTMS treatment.

Results: The fNIRS-guided hotspot (fNIRS-HS) was obtained for each patient, even those for whom the MEP-guided hotspot was undetectable. Both intervention groups exhibited significant improvements in muscle strength, FMA, and WMFT scores (P < 0.001) compared with the sham group. The fNIRS group achieved significantly greater improvement in elbow function (P = 0.001) than the MEP group.

Conclusion: fNIRS can be a reliable tool for hotspot navigation for motor neuromodulation in patients with stroke. With high sensitivity to cortical oxygenation changes, this navigation system achieved a superior outcome to the traditional MEP-based method in patients with stroke. fNIRS-based systems may also facilitate the integration of machine learning, thus enabling precision medicine for neuromodulation.

Trial registration: https://ichgcp.net/clinical-trials-registry/NCT02006615" title="See in ClinicalTrials.gov">NCT02006615.

Keywords: Cortical excitability; Motor function; Near-infrared spectroscopy (NIRS); Repetitive transcranial magnetic stimulation (rTMS); Stroke.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT flowchart
Fig. 2
Fig. 2
Arrangement of fNIRS probes covering the bilateral premotor cortex, primary motor cortex (M1), and supplemental motor area (SMA). ∆[HbO] at S4D2 CH 9, S5D3 CH13, S5D8 CH16, and S8D7 CH 22 yielded significant correlation with RMT in the contralesional hemisphere
Fig. 3
Fig. 3
a Shows that in the reconstructed [HbO] signals without any motion correction, contamination of spike noise is observed (black arrows). In b, the spikes are effectively eliminated using the wavelet-based method. However, an overestimation of [HbO] response (a relatively stronger amplitude compared to other blocks) was identified (the purple arrow). In c, the additional CBSI processing, with the consideration of both [HbO] and [HbR] signal profiles, further reduces this overestimation of [HbO] response and restores the negative correlation between [HbO] and [HbR] changes
Fig. 4
Fig. 4
Location of MEP-guided and fNIRS-guided hotspot related to Cz position on the skull surface. The same numbers indicate paired fNIRS-HS and MEP-HS. Green color: fNIRS-HS, red color: MEP-HS, solid circle or solid square: mean group location
Fig. 5
Fig. 5
Results of mean group data and intergroup comparisons for motor assessments in the three groups. The intergroup comparison was performed using one-way ANOVA and a post hoc analysis with Bonferroni's correction. Significance level: ***P < 0.001; **P < 0.01; *P < 0.05

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