Effects of different magnetic stimulation paradigms on post-stroke upper limb function: a randomized controlled trial

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Medical Technology

Background:

• Repetitive transcranial magnetic stimulation (rTMS) and repetitive peripheral magnetic stimulation (rPMS) show promise for post-stroke upper limb recovery.
• Comparative data on the efficacy and neural mechanisms of rTMS, rPMS, and their combination is limited.

Purpose of the Study:

• To compare the therapeutic effects of rTMS, rPMS, and combined protocols on upper limb functional recovery in stroke patients.
• To analyze functional outcomes and neural mechanisms to guide clinical selection of these non-invasive brain stimulation techniques.

Main Methods:

• Fifty-one stroke patients were randomized into rTMS, rPMS, or combined treatment groups for 3 weeks.
• Functional assessments included Fugl-Meyer assessment for the upper limb (FMA-UL), Thumb Localizing Test (TLT), and modified Barthel index (MBI).
• Resting-state functional magnetic resonance imaging (rs-fMRI) was used to evaluate neural changes via amplitude of low-frequency fluctuation (ALFF).

Main Results:

• Combined therapy yielded significantly greater improvements in FMA-UL and MBI scores compared to rTMS or rPMS alone.
• Both combined therapy and rPMS showed significant improvements in TLT scores over rTMS, with no significant difference between combined and rPMS.
• rPMS and combined therapy modulated ALFF in distinct and overlapping brain regions, including the frontal cortex and cerebellum, suggesting different neural underpinnings.

Conclusions:

• Repetitive peripheral magnetic stimulation (rPMS) offers advantages over rTMS for improving post-stroke proprioception.
• Combination therapy demonstrates superior efficacy in enhancing both motor function and proprioception recovery.
• Combined rTMS and rPMS therapy is recommended for promoting comprehensive brain and limb function recovery after stroke.