Intermittent theta burst stimulation enhances upper limb motor function in patients with chronic stroke: a pilot randomized controlled trial

Yu-Jen Chen, Ying-Zu Huang, Chung-Yao Chen, Chia-Ling Chen, Hsieh-Ching Chen, Ching-Yi Wu, Keh-Chung Lin, Tzu-Ling Chang, Yu-Jen Chen, Ying-Zu Huang, Chung-Yao Chen, Chia-Ling Chen, Hsieh-Ching Chen, Ching-Yi Wu, Keh-Chung Lin, Tzu-Ling Chang

Abstract

Background: Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial stimulation that has been used to enhance upper limb (UL) motor recovery. However, only limited studies have examined its efficacy in patients with chronic stroke and therefore it remains controversial.

Methods: This was a randomized controlled trial that enrolled patients from a rehabilitation department. Twenty-two patients with first-ever chronic and unilateral cerebral stroke, aged 30-70 years, were randomly assigned to the iTBS or control group. All patients received 1 session per day for 10 days of either iTBS or sham stimulation over the ipsilesional primary motor cortex in addition to conventional neurorehabilitation. Outcome measures were assessed before and immediately after the intervention period: Modified Ashworth Scale (MAS), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block test (BBT), and Motor Activity Log (MAL). Analysis of covariance was adopted to compare the treatment effects between groups.

Results: The iTBS group had greater improvement in the MAS and FMA than the control group (η2 = 0.151-0.233; p < 0.05), as well as in the ARAT and BBT (η2 = 0.161-0.460; p < 0.05) with large effect size. Both groups showed an improvement in the BBT, and there were no significant between-group differences in MAL changes.

Conclusions: The iTBS induced greater gains in spasticity decrease and UL function improvement, especially in fine motor function, than sham TBS. This is a promising finding because patients with chronic stroke have a relatively low potential for fine motor function recovery. Overall, iTBS may be a beneficial adjunct therapy to neurorehabilitation for enhancing UL function. Further larger-scale study is warranted to confirm the findings and its long-term effect.

Trial registration: This trial was registered under ClinicalTrials.gov ID No. NCT01947413 on September 20, 2013.

Keywords: Motor function; Rehabilitation; Stroke; Theta burst stimulation (TBS); Transcranial magnetic stimulation (TMS).

Conflict of interest statement

Ethics approval and consent to participate

The study protocol was performed in accordance with the Declaration of Helsinki and was approved by local ethics committee of Chang Gung Memorial Hospital, Taiwan. All patients gave written informed consent prior to participation.

Consent for publication

Not applicable.

Competing interests

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. No party has direct interest neither a financial relationship nor will they be conferred any benefits from writing this submission or the results of this research.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Consort diagram of participant recruitment and randomization
Fig. 2
Fig. 2
Study design
Fig. 3
Fig. 3
Changes in upper limb motor function before and after intervention

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