ArticleFrontiers in neurology2025
Effects of theta burst peripheral magnetic stimulation on cortical excitability and upper limb function after stroke: protocol for a randomized controlled trial.
Article in Frontiers in neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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Abstract
Introduction: Post-stroke spasticity affects 25%-40% of survivors, causing pain and functional impairment. Current non-invasive treatments target either central or peripheral pathways alone. This neglects the critical imbalance between spastic agonists and antagonists. We designed this protocol to address this gap through dual-site peripheral theta-burst stimulation. Methods: This single-center, three-arm, sham-controlled, single-blind randomized controlled trial enrolled 54 stroke survivors (aged 40-80, 3-12 months post-stroke, Modified Ashworth Scale score ≥1). Participants were randomized in a 1:1:1 ratio to receive a 10-session intervention over 2 weeks (5 days/week). Each session consisted of stimulation followed by 30 min of conventional physical therapy. The stimulation protocols were: Group 1: active iTBS over extensor carpi radialis longus + sham cTBS over flexor carpi radialis; Group 2: sham iTBS + active cTBS; Group 3: active iTBS + active cTBS. Stimulation was delivered using a MagTD stimulator at 110%-120% of the peripheral motor threshold (mean 38.4% maximum stimulator output), with 600 pulses per session (50 Hz burst frequency, 5 Hz theta rhythm). Anticipated results: We hypothesize that Group 3 (combined stimulation) will yield the greatest reduction in spasticity (MAS decrease ≥ 1) and the most significant improvements in upper-limb function (FMA-UE, ARAT) compared to Groups 1 and 2. These clinical gains are expected to correlate with neurophysiological changes (MEP amplitude, cortical silent period), supporting the central-peripheral synergy model. Discussion: This protocol tests a novel dual-site pTBS paradigm. Positive findings would provide preliminary evidence for network-based rehabilitation. This could inform larger trials and potentially transform post-stroke spasticity management.
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