Multifocal transcranial stimulation in chronic ischemic stroke: A phase 1/2a randomized trial

Chiu, David; McCane, Charles D.; Lee, Jason; John, Blessy; Nguyen, Lisa; Butler, Kayla; Gadhia, Rajan; Misra, Vivek; Volpi, John; Verma, Amit; Helekar, Santosh

doi:10.1016/j.jstrokecerebrovasdis.2020.104816

Cited by 10 publications

(5 citation statements)

References 41 publications

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“…HF rTMS, iTBS, LF rTMS, or TRPMS improved upper limb muscle synergies in 467 patients from 8 studies (SMD, 0.38 [95% CI, 0.01–0.75]; I 2 , 65%). 51–58…”

Section: Resultsmentioning

confidence: 99%

“…There was no statistically significant effect of HF rTMS, iTBS, LF rTMS, or TRPMS on muscle strength in 127 patients from 5 studies (SMD, 0.34 [95% CI, −0.01 to 0.70]; I 2 , 0%). 45,52,55–57…”

Section: Resultsmentioning

confidence: 99%

“…HF rTMS, iTBS, LF rTMS, or TRPMS improved upper limb muscle synergies in 467 patients from 8 studies (SMD, 0.38 [95% CI, 0.01-0.75]; I 2 , 65%). [51][52][53][54][55][56][57][58] There was no statistically significant effect of HF rTMS or LF rTMS on lower limb muscle synergies in 72 patients from 3 studies (SMD, −0.15 [95% CI, −0.98 to 0.69]; I 2 , 68%). [58][59][60] There was no statistically significant effect of HF rTMS, iTBS, LF rTMS, or TRPMS on muscle strength in 127 patients from 5 studies (SMD, 0.34 [95% CI, −0.01 to 0.70]; I 2 , 0%).…”

Section: Effects Of Rtms Beyond 3 Months After Stroke At the Level Of...mentioning

confidence: 98%

“…[58][59][60] There was no statistically significant effect of HF rTMS, iTBS, LF rTMS, or TRPMS on muscle strength in 127 patients from 5 studies (SMD, 0.34 [95% CI, −0.01 to 0.70]; I 2 , 0%). 45,52,[55][56][57] HF rTMS, iTBS, or LF rTMS was associated with improved global cognitive functioning in 99 patients from 2 studies (SMD, 0.67 [95% CI, 0.26-1.08]; I 2 , 0%). 61,62 HF rTMS was associated with improved visual and spatial attention in 58 patients from 1 study (SMD, 0.88 [95% CI, 0.34-1.42).…”

Section: Effects Of Rtms Beyond 3 Months After Stroke At the Level Of...mentioning

confidence: 99%

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Evidence of rTMS for Motor or Cognitive Stroke Recovery: Hype or Hope?

Hofmeijer,

Ham,

Kwakkel

2023

Stroke

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BACKGROUND: Evidence of efficacy of repetitive transcranial magnetic stimulation (rTMS) for stroke recovery is hampered by an unexplained variability of reported effect sizes and an insufficient understanding of mechanisms of action. We aimed to (1) briefly summarize evidence of efficacy, (2) identify critical factors to explain the reported variation in effects, and (3) provide mechanism-based recommendations for future trials. METHODS: We performed a systematic review of the literature according to Cochrane and PRISMA Protocols. We included trials with ≥10 patients per treatment group. We classified outcome measures according to the International Classification of Functioning, Disability, and Health. Meta-analysis was done when at least 3 trials were reported on the same construct. In case of significant summary effect sizes with significant heterogeneity, we used sensitivity analyses to test for correlations and differences between found individual effect sizes and possible effect modifiers such as patient-, repetitive transcranial magnetic stimulation-, and trial characteristics. RESULTS: We included 57 articles (N=2595). Funnel plots showed no publication bias. We found significant effect sizes at the level of body function (upper limb synergies, muscle strength, language functioning, global cognitive functioning, visual/spatial inattention) with repetitive transcranial magnetic stimulation within or beyond 3 months after stroke. We also found significant effect sizes at the level of activities. We found no subgroup differences or significant correlations between individual summary effect sizes and any tested possible effect modifier. CONCLUSIONS: Repetitive transcranial magnetic stimulation holds the potential to benefit a range of motor and cognitive outcomes after stroke, but the evidence of efficacy is challenged by unexplained heterogeneity across many small sampled trials. We propose large trials with the collection of individual patient data on baseline severity and brain network integrity with sufficiently powered subgroup analyses, as well as protocolized time-locked training of the target behavior. Additional neurophysiological and biomechanical data may help in understanding mechanisms and identifying biomarkers of treatment efficacy. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: CRD42022300330.

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“…HF rTMS, iTBS, LF rTMS, or TRPMS improved upper limb muscle synergies in 467 patients from 8 studies (SMD, 0.38 [95% CI, 0.01–0.75]; I 2 , 65%). 51–58…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Effects Of Rtms Beyond 3 Months After Stroke At the Level Of...mentioning

confidence: 98%

Section: Effects Of Rtms Beyond 3 Months After Stroke At the Level Of...mentioning

confidence: 99%

See 2 more Smart Citations

Evidence of rTMS for Motor or Cognitive Stroke Recovery: Hype or Hope?

Hofmeijer,

Ham,

Kwakkel

2023

Stroke

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“…Experimental justification for these parameters was based on previous studies with TRPMS. 7,12,13 Up to 6 microstimulators can be attached onto a neoprene cap worn on the head to modulate desired cortical locations. The microstimulators are connected by a cable to, and activated by, a stimulator console, ie controlled by a tablet, and consists of an electronic circuit and a microprocessor.…”

Section: Intervention and Data Acquisitionmentioning

confidence: 99%

Noninvasive, Individualized Cortical Modulation Using Transcranial Rotating Permanent Magnet Stimulator for Voiding Dysfunction in Women with Multiple Sclerosis: A Pilot Trial

et al. 2022

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Purpose:Voiding dysfunction (VD) leading to urinary retention is a common neurogenic lower urinary tract symptom in patients with multiple sclerosis (MS). Currently, the only effective management for patients with MS with VD is catheterization. Transcranial Rotating Permanent Magnet Stimulator (TRPMS) is a noninvasive, portable, multifocal neuromodulator that simultaneously modulates multiple cortical regions and the strength of their functional connections. In this pilot trial (ClinicalTrials.gov Identifier: NCT03574610), we investigated the safety and therapeutic effects of TRPMS in modulating brain regions of interest (ROIs) engaged with voiding initiation to improve VD in MS women.Materials and Methods:Ten MS women with VD (having % post-void residual/bladder capacity [%PVR/BC] ≥40% or being in the lower 10th percentile of the Liverpool nomogram) underwent concurrent functional magnetic resonance imaging/urodynamic study (fMRI/UDS) with 3 cycles of bladder filling/emptying, at baseline and post-treatment. Predetermined ROIs and their activations at voiding initiation were identified on patients’ baseline fMRI/UDS scans, corresponding to microstimulator placement. Patients received 10 consecutive 40-minute treatment sessions. Brain activation group analysis, noninstrumented uroflow, and validated questionnaires were compared at baseline and post-treatment.Results:No treatment-related adverse effects were reported. Post-treatment, patients showed significantly increased activation in regions known to be involved at voiding initiation in healthy subjects. %PVR/BC significantly decreased. Significant improvement of bladder emptying symptoms were reported by patients via validated questionnaires.Conclusions:Both neuroimaging and clinical data suggested TRPMS effectively and safely modulated brain regions that are involved in the voiding phase of the micturition cycle, leading to clinical improvements in bladder emptying in patients with MS.

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