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Related Experiment Video

Updated: Jul 19, 2025

Randomized, Triple-Blind, and Parallel-Controlled Trial of Transcranial Direct Current Stimulation for Cognitive Rehabilitation after Stroke
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Electric Field Navigated 1-Hz rTMS for Poststroke Motor Recovery: The E-FIT Randomized Controlled Trial.

Dylan J Edwards1,2,3, Charles Y Liu4, Kari Dunning5

  • 1Moss Rehabilitation Research Institute, and Department of Rehabilitation Medicine Thomas Jefferson University, Philadelphia, PA (D.J.E.).

Stroke
|August 14, 2023
PubMed
Summary
This summary is machine-generated.

Low-frequency repetitive transcranial magnetic stimulation (rTMS) did not improve motor recovery in stroke patients when combined with intensive rehabilitation. While rehabilitation alone enhanced function and quality of life, rTMS showed no significant added benefit in this study.

Keywords:
odds ratiooutpatientsquality of lifestroketherapeuticsupper extremity

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Area of Science:

  • Neuroscience
  • Rehabilitation Medicine
  • Clinical Trials

Background:

  • Repetitive transcranial magnetic stimulation (rTMS) is explored as an adjunct to stroke rehabilitation.
  • The E-FIT trial extended the NICHE trial, investigating low-frequency rTMS on the primary motor cortex contralateral to the affected hemisphere in hemiparetic stroke patients.
  • This study utilized an alternative sham coil compared to the original NICHE trial.

Purpose of the Study:

  • To determine if low-frequency rTMS targeting the primary motor cortex contralateral to the affected corticospinal tract augments intensive training-related clinical improvement in hemiparetic stroke patients.
  • To evaluate the efficacy and safety of rTMS as an adjuvant therapy for post-stroke motor recovery.

Main Methods:

  • A parallel-arm randomized clinical trial (E-FIT) involving 60 hemiparetic stroke patients.
  • Participants received either 1 Hz rTMS or sham stimulation preceding 60-minute therapy sessions, 18 sessions over 6 weeks.
  • Outcomes included upper extremity Fugl-Meyer (primary), Action Research Arm Test, National Institutes of Health Stroke Scale, and quality of life (EQ-5D), assessed at multiple time points post-treatment.

Main Results:

  • Combined analysis of E-FIT and NICHE trials showed active rTMS was not superior to sham stimulation at the primary endpoint.
  • In the E-FIT trial, 60% of the active group and 50% of the sham group achieved significant upper extremity Fugl-Meyer improvement.
  • Both active and sham groups showed significant improvements in Fugl-Meyer, Action Research Arm Test, and EQ-5D; only the active group improved in NIH Stroke Scale.

Conclusions:

  • Intensive motor rehabilitation improves function and quality of life in stroke patients 3-12 months post-stroke.
  • 1 Hz-rTMS was not found to be an effective treatment adjuvant in this patient sample with mixed lesion characteristics.
  • Further research may be needed to identify specific patient subgroups who could benefit from rTMS therapy.