Personalized rTMS showed larger upper extremity improvement than standard rTMS in a small stroke trial
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Key Takeaway
Consider personalized rTMS for upper extremity impairment in stroke, noting small sample size and lack of safety data.
A randomized, triple-blind, single-center trial evaluated personalized rTMS guided by the PRESp-rTMS algorithm versus standard low-frequency rTMS on the non-lesioned hemisphere in 20 people with stroke aged 18 to 80 years presenting upper extremity motor impairment. The study population included individuals presenting with upper extremity motor impairment. No adverse events, serious adverse events, discontinuations, or tolerability data were reported.
The primary outcome measured the mean difference in the Fugl-Meyer Assessment for the Upper Extremity. The p-rTMS group achieved a mean difference of 11.8 ± 2.9, while the s-rTMS group achieved 4.9 ± 1.4. The p-value was less than 0.01 with a 95% confidence interval of 2.15 to 3.90. Cohen's D was 3.2. The direction indicated larger improvement in the p-rTMS group compared to the s-rTMS group.
Secondary outcomes included the Functional Independence Measure, Box and Block Test, Trunk Control Test, and Modified Ashworth Scale. No significant differences were found for these secondary outcomes, though very large effect sizes favored the p-rTMS group. P-values and confidence intervals for secondary outcomes were not reported.
Limitations include the small sample size of 20 participants and the lack of reported safety data. Follow-up duration was not reported. Funding or conflicts of interest were not reported. The practice relevance was not reported. These results suggest a potential benefit for the primary outcome but warrant further investigation in larger trials.
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View Original Abstract ↓
BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is a promising noninvasive treatment for upper extremity motor impairment in people with stroke. However, response variability underscores the need for tools to support more personalized and effective rTMS planning.
OBJECTIVES: Implement a biomarker-based PREScription for personalized rTMS (PRESp-rTMS) in stroke patients with upper extremity motor impairment and verify its effectiveness.
METHODS: In this randomized, triple-blind, single-center trial, 20 people with stroke, aged 18-80 years and presenting upper extremity motor impairment, were enrolled and assigned to either a control group receiving standard low-frequency rTMS (s-rTMS) on the non-lesioned hemisphere or a personalized rTMS (p-rTMS) group guided by the PRESp-rTMS algorithm, based on neurophysiological and clinical biomarkers. The p-rTMS group received one of four protocols, each targeting specific frequencies on a single or both hemispheres. The primary outcome was the mean difference in the Fugl-Meyer Assessment for the Upper Extremity (ΔFMA-UE). Secondary outcomes included the Functional Independence Measure, Box and Block Test, Trunk Control Test, and Modified Ashworth Scale.
RESULTS: Compared to the s-rTMS group (ΔFMA-UE = 4.9 ± 1.4; mean ± SD), the p-rTMS group demonstrated a larger improvement in upper extremity motor impairment (ΔFMA-UE = 11.8 ± 2.9; < 0.01; Cohen's D = 3.2, 95% CI = 2.15-3.90). No significant differences were found for secondary outcomes, although very large effect sizes favored the p-rTMS group.
CONCLUSIONS: Using the PRESp-rTMS algorithm results in greater improvements in upper extremity motor impairment in people with stroke compared to the standard rTMS protocol.
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