The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study

Objectives: Transcranial magnetic stimulation, in particular continuous theta burst (cTBS), has been proposed for stroke rehabilitation, based on the concept that inhibition of the healthy hemisphere helps promote the recovery of the lesioned one. We aimed to study its effects on cortical excitabili...

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Autores principales:	Ana Dionísio, Rita Gouveia, João Castelhano, Isabel Catarina Duarte, Gustavo C. Santo, João Sargento-Freitas, Felix Duecker, Miguel Castelo-Branco
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	continuous theta burst stimulation transcranial magnetic stimulation neurophysiology brain oscillations stroke neurorehabilitation Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/c95c0823185143b4b5be05bcfe9b023e
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spelling	oai:doaj.org-article:c95c0823185143b4b5be05bcfe9b023e2021-11-04T04:43:09ZThe Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study1664-229510.3389/fneur.2021.749798https://doaj.org/article/c95c0823185143b4b5be05bcfe9b023e2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.749798/fullhttps://doaj.org/toc/1664-2295Objectives: Transcranial magnetic stimulation, in particular continuous theta burst (cTBS), has been proposed for stroke rehabilitation, based on the concept that inhibition of the healthy hemisphere helps promote the recovery of the lesioned one. We aimed to study its effects on cortical excitability, oscillatory patterns, and motor function, the main aim being to identify potentially beneficial neurophysiological effects.Materials and Methods: We applied randomized real or placebo stimulation over the unaffected primary motor cortex of 10 subacute (7 ± 3 days) post-stroke patients. Neurophysiological measurements were performed using electroencephalography and electromyography. Motor function was assessed with the Wolf Motor Function Test. We performed a repeated measure study with the recordings taken pre-, post-cTBS, and at 3 months' follow-up.Results: We investigated changes in motor rhythms during arm elevation and thumb opposition tasks and found significant changes in beta power of the affected thumb's opposition, specifically after real cTBS. Our results are consistent with an excitatory response (increase in event-related desynchronization) in the sensorimotor cortical areas of the affected hemisphere, after stimulation. Neither peak-to-peak amplitude of motor-evoked potentials nor motor performance were significantly altered.Conclusions: Consistently with the theoretical prediction, this contralateral inhibitory stimulation paradigm changes neurophysiology, leading to a significant excitatory impact on the cortical oscillatory patterns of the contralateral hemisphere. These proof-of-concept results provide evidence for the potential role of continuous TBS in the neurorehabilitation of post-stroke patients. We suggest that these changes in ERS/ERD patterns should be further explored in future phase IIb/phase III clinical trials, in larger samples of poststroke patients.Ana DionísioAna DionísioAna DionísioRita GouveiaJoão CastelhanoJoão CastelhanoIsabel Catarina DuarteIsabel Catarina DuarteGustavo C. SantoJoão Sargento-FreitasFelix DueckerFelix DueckerFelix DueckerMiguel Castelo-BrancoMiguel Castelo-BrancoMiguel Castelo-BrancoMiguel Castelo-BrancoFrontiers Media S.A.articlecontinuous theta burst stimulationtranscranial magnetic stimulationneurophysiologybrain oscillationsstrokeneurorehabilitationNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	continuous theta burst stimulation transcranial magnetic stimulation neurophysiology brain oscillations stroke neurorehabilitation Neurology. Diseases of the nervous system RC346-429
spellingShingle	continuous theta burst stimulation transcranial magnetic stimulation neurophysiology brain oscillations stroke neurorehabilitation Neurology. Diseases of the nervous system RC346-429 Ana Dionísio Ana Dionísio Ana Dionísio Rita Gouveia João Castelhano João Castelhano Isabel Catarina Duarte Isabel Catarina Duarte Gustavo C. Santo João Sargento-Freitas Felix Duecker Felix Duecker Felix Duecker Miguel Castelo-Branco Miguel Castelo-Branco Miguel Castelo-Branco Miguel Castelo-Branco The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study
description	Objectives: Transcranial magnetic stimulation, in particular continuous theta burst (cTBS), has been proposed for stroke rehabilitation, based on the concept that inhibition of the healthy hemisphere helps promote the recovery of the lesioned one. We aimed to study its effects on cortical excitability, oscillatory patterns, and motor function, the main aim being to identify potentially beneficial neurophysiological effects.Materials and Methods: We applied randomized real or placebo stimulation over the unaffected primary motor cortex of 10 subacute (7 ± 3 days) post-stroke patients. Neurophysiological measurements were performed using electroencephalography and electromyography. Motor function was assessed with the Wolf Motor Function Test. We performed a repeated measure study with the recordings taken pre-, post-cTBS, and at 3 months' follow-up.Results: We investigated changes in motor rhythms during arm elevation and thumb opposition tasks and found significant changes in beta power of the affected thumb's opposition, specifically after real cTBS. Our results are consistent with an excitatory response (increase in event-related desynchronization) in the sensorimotor cortical areas of the affected hemisphere, after stimulation. Neither peak-to-peak amplitude of motor-evoked potentials nor motor performance were significantly altered.Conclusions: Consistently with the theoretical prediction, this contralateral inhibitory stimulation paradigm changes neurophysiology, leading to a significant excitatory impact on the cortical oscillatory patterns of the contralateral hemisphere. These proof-of-concept results provide evidence for the potential role of continuous TBS in the neurorehabilitation of post-stroke patients. We suggest that these changes in ERS/ERD patterns should be further explored in future phase IIb/phase III clinical trials, in larger samples of poststroke patients.
format	article
author	Ana Dionísio Ana Dionísio Ana Dionísio Rita Gouveia João Castelhano João Castelhano Isabel Catarina Duarte Isabel Catarina Duarte Gustavo C. Santo João Sargento-Freitas Felix Duecker Felix Duecker Felix Duecker Miguel Castelo-Branco Miguel Castelo-Branco Miguel Castelo-Branco Miguel Castelo-Branco
author_facet	Ana Dionísio Ana Dionísio Ana Dionísio Rita Gouveia João Castelhano João Castelhano Isabel Catarina Duarte Isabel Catarina Duarte Gustavo C. Santo João Sargento-Freitas Felix Duecker Felix Duecker Felix Duecker Miguel Castelo-Branco Miguel Castelo-Branco Miguel Castelo-Branco Miguel Castelo-Branco
author_sort	Ana Dionísio
title	The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study
title_short	The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study
title_full	The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study
title_fullStr	The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study
title_full_unstemmed	The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study
title_sort	role of continuous theta burst tms in the neurorehabilitation of subacute stroke patients: a placebo-controlled study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/c95c0823185143b4b5be05bcfe9b023e
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The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study

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