TY - JOUR
T1 - Theta burst stimulation for enhancing upper extremity motor functions after stroke
T2 - a systematic review of clinical and mechanistic evidence
AU - Zhang, Jiaqi
AU - Sui, Youxin
AU - Sack, Alexander T.
AU - Bai, Zhongfei
AU - Kwong, Wai Hang
AU - Sanchez Vidana, Dalinda Isabel
AU - Li, Xiong
AU - Fong, Kenneth N. K.
N1 - Publisher Copyright:
© 2024 Walter de Gruyter GmbH, Berlin/Boston.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - This systematic review aimed to evaluate the effects of different theta burst stimulation (TBS) protocols on improving upper extremity motor functions in patients with stroke, their associated modulators of efficacy, and the underlying neural mechanisms. We conducted a meta-analytic review of 29 controlled trials published from January 1, 2000, to August 29, 2023, which investigated the effects of TBS on upper extremity motor, neurophysiological, and neuroimaging outcomes in poststroke patients. TBS significantly improved upper extremity motor impairment (Hedge’s g = 0.646, p = 0.003) and functional activity (Hedge’s g = 0.500, p < 0.001) compared to controls. Meta-regression revealed a significant relationship between the percentage of patients with subcortical stroke and the effect sizes of motor impairment (p = 0.015) and functional activity (p = 0.018). Subgroup analysis revealed a significant difference in the improvement of upper extremity motor impairment between studies using 600-pulse and 1200-pulse TBS (p = 0.002). Neurophysiological studies have consistently found that intermittent TBS increases ipsilesional corticomotor excitability. However, evidence to support the regional effects of continuous TBS, as well as the remote and network effects of TBS, is still mixed and relatively insufficient. In conclusion, TBS is effective in enhancing poststroke upper extremity motor function. Patients with preserved cortices may respond better to TBS. Novel TBS protocols with a higher dose may lead to superior efficacy compared with the conventional 600-pulse protocol. The mechanisms of poststroke recovery facilitated by TBS can be primarily attributed to the modulation of corticomotor excitability and is possibly caused by the recruitment of corticomotor networks connected to the ipsilesional motor cortex.
AB - This systematic review aimed to evaluate the effects of different theta burst stimulation (TBS) protocols on improving upper extremity motor functions in patients with stroke, their associated modulators of efficacy, and the underlying neural mechanisms. We conducted a meta-analytic review of 29 controlled trials published from January 1, 2000, to August 29, 2023, which investigated the effects of TBS on upper extremity motor, neurophysiological, and neuroimaging outcomes in poststroke patients. TBS significantly improved upper extremity motor impairment (Hedge’s g = 0.646, p = 0.003) and functional activity (Hedge’s g = 0.500, p < 0.001) compared to controls. Meta-regression revealed a significant relationship between the percentage of patients with subcortical stroke and the effect sizes of motor impairment (p = 0.015) and functional activity (p = 0.018). Subgroup analysis revealed a significant difference in the improvement of upper extremity motor impairment between studies using 600-pulse and 1200-pulse TBS (p = 0.002). Neurophysiological studies have consistently found that intermittent TBS increases ipsilesional corticomotor excitability. However, evidence to support the regional effects of continuous TBS, as well as the remote and network effects of TBS, is still mixed and relatively insufficient. In conclusion, TBS is effective in enhancing poststroke upper extremity motor function. Patients with preserved cortices may respond better to TBS. Novel TBS protocols with a higher dose may lead to superior efficacy compared with the conventional 600-pulse protocol. The mechanisms of poststroke recovery facilitated by TBS can be primarily attributed to the modulation of corticomotor excitability and is possibly caused by the recruitment of corticomotor networks connected to the ipsilesional motor cortex.
KW - cortical excitability
KW - neuroplasticity
KW - stroke
KW - theta burst stimulation
KW - upper extremity
UR - http://www.scopus.com/inward/record.url?scp=85191871678&partnerID=8YFLogxK
U2 - 10.1515/revneuro-2024-0030
DO - 10.1515/revneuro-2024-0030
M3 - Review article
SN - 0334-1763
VL - 35
SP - 679
EP - 695
JO - Reviews in the Neurosciences
JF - Reviews in the Neurosciences
IS - 6
ER -