Intermittent theta burst stimulation enhances upper limb motor function in patients with chronic stroke: A randomized controlled trial

Abstract

Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial stimulation to enhance upper limb (UL) motor recovery. However, only limited studies have examined its efficacy in patients with chronic stroke and therefore it remains controversial. This was a double-blind randomized controlled trial that enrolled patients from a rehabilitation department. Twenty-two patients with first-ever chronic and unilateral cerebral stroke, aged 30–70 years, were randomly assigned to the iTBS or sham group. All patients received 10 daily sessions of either iTBS or sham stimulation over the ipsilesional primary motor cortex in addition to conventional neurorehabilitation. Outcome measures were implemented before and immediately after the intervention period: Modified Ashworth Scale (MAS), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block test (BBT), and Motor Activity Log (MAL). Analysis of covariance was used to compare treatment effects between groups. The iTBS group showed greater improvement in the MAS and FMA than the sham group ( η 2 = 0.151–0.233; P < 0.05), as well as in the ARAT and BBT ( η 2 = 0.161–0.460; P < 0.05) with large effect size. Both groups showed an improvement in the BBT, and there were no significant between-group differences in the changes in the MAL. The iTBS induced greater gains in spasticity decrease and UL function improvement, especially in fine motor function, than sham TBS. This is a promising finding because patients with chronic stroke generally have a low potential for fine motor recovery. Overall, iTBS may be a beneficial adjunct therapy to neurorehabilitation for enhancing UL function.