Improving Motivation in Post-stroke Apathy with Repetitive Transcranial Magnetic Stimulation (IMPART): A Phase-I...

Area of Science:

• Neuroscience
• Neurology
• Psychiatry

Background:

• Post-stroke apathy (PSA) is a common and disabling condition following stroke.
• Limited evidence-based treatment options exist for PSA.
• The dorsomedial prefrontal cortex (dmPFC) is implicated in apathy and is a potential target for neuromodulation.

Purpose of the Study:

• To evaluate the safety, feasibility, and efficacy of an accelerated intermittent theta burst stimulation-repetitive transcranial magnetic stimulation (iTBS-rTMS) protocol targeting the left dmPFC in chronic stroke survivors with apathy.
• To assess the impact of iTBS-rTMS on apathy symptoms, neuropsychiatric symptoms, and psychosocial functioning.

Main Methods:

• Fourteen chronic stroke survivors with apathy received an open-label, accelerated iTBS-rTMS protocol targeting the left dmPFC.
• The protocol involved 21,600 pulses over 36 sessions across 3 days.
• Safety was assessed through adverse events and cognitive performance; efficacy was measured using apathy scales, quality of life, and caregiver burden scales, with a one-month follow-up.

Main Results:

• No serious adverse events were reported, and cognitive performance remained stable.
• Participants showed significant improvements in apathy symptoms, with moderate to large effect sizes on both self- and caregiver-rated scales (Lille Apathy Rating Scale).
• Secondary outcomes also demonstrated significant improvements in quality of life, caregiver burden, and psychosocial functioning.

Conclusions:

• Accelerated iTBS-rTMS targeting the left dmPFC is a safe, feasible, and well-tolerated treatment for post-stroke apathy in chronic stroke survivors.
• Preliminary evidence suggests this protocol can effectively reduce apathy and improve related psychosocial outcomes.
• This approach offers a promising new intervention for a patient group with limited treatment options.