CLINICAL TRIAL article
Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1634277
The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: An Exploratory Randomized Controlled Trial
Provisionally accepted
Songbin Chen1
Xiaotong Li2Wenqing Yang2
Guiyuan Cai2Shunxi Zhang2Yujie Chen2Wenyu Chen2Frank Kulwa1Huangjie Huang3Lanfang Xie1Lingling Tian1Yangkang Zeng1
Hai Li1*- 1Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- 2Guangzhou First People's Hospital, Guangzhou, China
- 3The First Affiliated Hospital, Sun Yat-sen University,, Guangzhou, China
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Background: Stroke often results in significant motor impairments, particularly in the upper limbs, which can severely impact functional independence and quality of life. Conventional rehabilitation methods provide limited recovery, necessitating the exploration of adjunctive therapies to enhance motor function. Intermittent theta burst stimulation (iTBS) is a brain stimulation technique that has shown promise in improving motor function after stroke. This study was conducted to investigate whether iTBS targeting ipsilesional primary motor cortex can induce improvements of the paretic upper limb and physiological changes in cortical excitability in subacute stroke patients. Methods:50 patients were randomized assigned to either iTBS or sham stimulation across 10 sessions. Motor function, symptom severity, muscle tone, and functional independence were evaluated. Additional measures included rest motor threshold (RMT), oxygenated hemoglobin concentration. Results: Both the iTBS and sham groups showed significant improvements in National Institutes of Health Stroke Scale (NIHSS) (iTBS: p=0.002; sham: p=0.039), Fugl-Meyer Assessment (FMA) (iTBS: p<0.001; sham: p=0.005), and Modified Barthel Index (MBI) (iTBS: p<0.001; sham: p=0.002) scores post-intervention. Only the iTBS group demonstrated significant improvements in Modified Ashworth Scale (MAS) (p<0.001), Wolf Motor Function Test (WMFT) (p<0.001), and RMT (p=0.016). The iTBS group exhibited a trend toward greater improvements in MAS (p=0.001), WMFT (p=0.002), and MBI (p<0.001). RMT in contralateral Primary motor cortex (M1) was significantly lower in the iTBS group (p=0.016), and functional connectivity between each M1 regions was notably enhanced (p=0.049). Conclusion: These findings suggest that iTBS may offer additional benefits in improving functional task performance and cortical connectivity in subacute stroke patients.
Keywords: iTBS, Stroke, Motor function, Muscle tone, functional connectivity
Received: 24 May 2025; Accepted: 01 Sep 2025.
Copyright: © 2025 Chen, Li, Yang, Cai, Zhang, Chen, Chen, Kulwa, Huang, Xie, Tian, Zeng and Li. 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: Hai Li, Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
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