Effects of transcranial combined with peripheral repetitive magnetic stimulation on limb spasticity and resting-state brain activity in stroke patients

Abstract

Background and objectiveTranscranial magnetic stimulation and peripheral repetitive magnetic stimulation (rPMS), as non-invasive neuromodulation techniques, can promote functional recovery in patients with post-stroke spasticity (PSS), but the effects of transcranial magnetic stimulation combined with peripheral magnetic stimulation on PSS remain largely unknown. Therefore, we examined the effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with rPMS on PSS patients and its potential neural correlates to behavioral improvements.MethodsForty-nine PSS patients were divided randomly into three groups: a combined group (n = 20), a LF-rTMS group (n = 15), and a control group (n = 14). The combined group received LF-rTMS and rPMS treatment, the rTMS group received LF-rTMS treatment, and the control group received only routine rehabilitation. All patients underwent Ashworth Spasm Scale (MAS), upper extremity Fugl-Meyer (FMA-UE), and modified Barthel Index (MBI) assessments before and after intervention. In addition, resting-state functional magnetic resonance imaging data were collected pre- and post-treatment to observe changes in the amplitude of low-frequency fluctuation (ALFF).ResultsThe MAS score was decreased, FMA-UE score and MBI scores were increased in the three groups after therapy than before therapy (all P < 0.05). In particular, the combined group showed significant effect on improved motor function and relieved spasticity in PSS (P < 0.01). Moreover, the combined treatment increased ALFF values mainly in the right supplementary motor area, right middle frontal gyrus, and right cerebellum, while reduced ALFF values mainly in the right post-central gyrus compared with pre-treatment. Compared with the LF-rTMS and control groups, the combined treatment increased ALFF values in the right cerebellum and reduced ALFF values mainly in the frontoparietal cortex. Improvements in the MAS score were positively correlated with the change in ALFF values in the right cerebellum (r = 0.698, P = 0.001) and the right supplementary motor area (r = 0.700, P = 0.001) after combined treatment.ConclusionTranscranial combined with peripheral repetitive magnetic stimulation could improve spastic state and motor function in PSS patients, and this effect may be associated with altered cerebellar and frontoparietal cortical activity.Clinical trial registrationhttp://www.chictr.org.cn/index.aspx, identifier ChiCTR1800019452.

Effects of combined treatment with transcranial and peripheral electromagnetic stimulation on performance and pain recovery from delayed onset muscle soreness induced by eccentric exercise in young athletes. A randomized clinical trial

“…Transcranial stimulation modulates the excitability of the primary motor cortex, involved in the planning and execution of movement, while peripheral stimulation directly activates muscle fibers, resulting in a faster and more powerful muscle response. The simultaneous activation of the central and peripheral nervous systems can lead to greater efficiency in force generation and movement execution (Matsuo et al, 2022;Qin et al, 2023). Regarding the 30 m sprint, our results resemble those of Pearcey et al (2015), who observed an improvement in running time after inducing DOMS (Pearcey et al, 2015).…”

The mechanism of Sangdantongluo granule in treating post-stroke spasticity based on multimodal fMRI combined with TMS: Study protocol

“…Using static functional magnetic resonance imaging, Gottlieb found that low-frequency rTMS reduces spasticity by stimulating neural plasticity and increasing functional connections between the cerebral cortex [ 40 ]. Peripheral repetitive magnetic stimulation may improve spasms by increasing affected cortex excitability and motor cortex functional reorganization [ 41 ]. The main mechanism of botulinum toxin A in treating PSS is regulating maladaptive plasticity [ 42 ], which may also be the focus of acupuncture, moxibustion, Tui Na, and other therapies [ 43 ].…”

Synergistic efficacy of repetitive peripheral magnetic stimulation on central intermittent theta burst stimulation for upper limb function in patients with stroke: a double-blinded, randomized controlled trial

“…To date, the majority of studies have focused on the effects of integrating rPMS with rehabilitation programs [ 20 – 22 ] for patients with stroke. Currently, one study showed that central rTMS combined with rPMS altered cerebellar and frontoparietal cortical activity via functional magnetic images [ 26 ]. One study combined rTMS with rPMS to improved patient’s spasticity and motor function [ 27 ].…”

“…One study combined rTMS with rPMS to improved patient’s spasticity and motor function [ 27 ]. While the individual benefits of central rTMS and rPMS have been documented in previous studies [ 26 , 27 ], our rationale for combining them is based on emerging evidence that rPMS can modulate motor cortical excitability in the central nervous system [ 13 – 15 ]. Furthermore, the iTBS was proved to have more enduring effects than the conventional rTMS [ 2 , 28 ].…”