Cerebellar Intermittent Theta-Burst Stimulation Reduces Upper Limb Spasticity After Subacute Stroke: A Randomized Controlled Trial.

Yi Chen,Qing-Chuan Wei,Ming-Zhi Zhang,Ling-Yi Liao,Yun-Juan Xie,Qiang Gao,Qi-Fan Guo,Hui-Xin Tan

doi:10.3389/fncir.2021.655502

Abstract

Objective: This study aims to explore the efficacy of cerebellar intermittent theta-burst stimulation (iTBS) on upper limb spasticity in subacute stroke patients.Methods: A total of 32 patients with upper limb spasticity were enrolled and randomly assigned to treatment with cerebellar iTBS or sham stimulation before conventional physical therapy daily for 2 weeks. The primary outcomes included the modified Ashworth scale (MAS), the modified Tardieu scale (MTS), and the shear wave velocity (SWV). The secondary outcomes were the H-maximum wave/M-maximum wave amplitude ratio (Hmax/Mmax ratio), motor-evoked potential (MEP) latency and amplitude, central motor conduction time (CMCT), and the Barthel Index (BI). All outcomes were evaluated at baseline and after 10 sessions of intervention.Results: After the intervention, both groups showed significant improvements in the MAS, MTS, SWV, and BI. In addition, patients treated with cerebellar iTBS had a significant increase in MEP amplitude, and patients treated with sham stimulation had a significant decrease in Hmax/Mmax ratio. Compared with the sham stimulation group, the MAS, MTS, and SWV decreased more in the cerebellar iTBS group.Conclusion: Cerebellar iTBS is a promising adjuvant tool to reinforce the therapeutic effect of conventional physical therapy in upper limb spasticity management after subacute stroke (Chinese Clinical Trial Registry: ChiCTR1900026516).

Highlights

Poststroke spasticity (PSS) is a motor disorder clinically manifested as a velocity-dependent increase in stretch reflexes due to the hyperexcitability of alpha motor neurons in the spinal cord (Ward, 2012)
The Results of Primary Outcomes The Mann–Whitney U test showed that 2 weeks of cerebellar Intermittent theta-burst stimulation (iTBS) coupled with conventional physical therapy resulted in the decreases of the modified Ashworth scale (MAS) scores for affected elbow flexors and wrist flexors compared with sham stimulation
Wilcoxon matched-pairs signed-rank test revealed that both groups showed a significant decrease in the MAS scores of elbow flexors, and the cerebellar iTBS group showed the improvement in the MAS scores of wrist flexors (P < 0.001)

Summary

Introduction

Poststroke spasticity (PSS) is a motor disorder clinically manifested as a velocity-dependent increase in stretch reflexes due to the hyperexcitability of alpha motor neurons in the spinal cord (Ward, 2012). It is one of the most common complications after stroke, affecting 19–43% of survivors (Aloraini et al, 2015; Cai et al, 2017). Pain, loss of dexterity, stiffness, fibrosis, and atrophy followed by upper limb PSS always contribute to disordered motor control, functional limitations, and poor quality of life that result in an increased burden on caregivers (Leo et al, 2017; Li et al, 2019). Conventional physical therapy, one of the non-pharmacological options, is strongly recommended for patients with clinically significant spasticity (Khan et al, 2019)

Methods

Results

Discussion

Conclusion