CLINICAL TRIAL article
Front. Neurol.
Sec. Neurorehabilitation
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1587928
This article is part of the Research TopicNeuromodulation Techniques, Mechanisms, and Potential Benefits for Physical Activity Participation and Human PerformanceView all 9 articles
Effect of repetitive transcranial magnetic stimulation on upper limb motor function in stroke patients with right hemiplegia based on EEG microstates and EMG
Provisionally accepted
- 1Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- 2Chengdu Jincheng College, Chengdu, Sichuan Province, China
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Stroke severely impacts neural function and daily life, necessitating innovative rehabilitation strategies. This study investigated transcranial magnetic stimulation (TMS) effects on upper limb motor recovery in 20 right-hemiplegic stroke patients and 20 healthy controls, integrating EEG microstate analysis and EMG to assess neuromuscular changes. Patients underwent Fugl-Meyer Assessment (FMA-UE) and Action Research Arm Test (ARAT) pre-and post-rTMS, with resting-state EEG/EMG recorded before and after one week of rTMS intervention. Post-rTMS, patients showed significant improvements in FMA-UE and ARAT scores (p<0.05). Microstate analysis revealed that stroke patients initially exhibited reduced time coverage and occurrence frequency of Microstate B (linked to sensorimotor integration, p<0.05). After rTMS, Microstate B parameters significantly increased, approaching healthy control levels (p<0.05). Conversely, Microstate C (associated with motor execution) and Microstate D (attention-related) showed reduced duration and coverage post-rTMS (p<0.05). Critically, improvements in Microstate B correlated with enhanced motor coordination in specific muscles (flexor/extensor carpi ulnaris, p<0.05), while Microstate C changes positively correlated with increased upper limb strength. These findings highlight two key mechanisms: (1) rTMS enhances motor recovery in right-hemiplegic patients by modulating cortical dynamics, evidenced by microstate normalization; (2) Microstate B and C serve as biomarkers for tracking rehabilitation progress, with Microstate B reflecting motor coordination and Microstate C indicating strength recovery. The study bridges neurophysiological changes (microstate reorganization) and functional outcomes, supporting rTMS as a precision tool for post-stroke neurorehabilitation. By identifying microstate-specific responses to rTMS, this work advances personalized rehabilitation strategies, aligning with the growing demand for biomarker-driven interventions in neurology. Future studies should validate these biomarkers in larger cohorts and optimize rTMS protocols based on microstate profiles.
Keywords: rTMS (repetitive Transcranial Magnetic Stimulation), Stroke, Microstates, EEG, EMG - Electromyogram
Received: 05 Mar 2025; Accepted: 02 Sep 2025.
Copyright: © 2025 Yu, Xin, Xie, Cheng, Ling, Wei and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xin Wei, Chengdu Jincheng College, Chengdu, Sichuan Province, China
Pu Wang, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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