scholarly journals Theta burst stimulation a new paradigm of non-invasive brain stimulation for post-stroke upper limb motor rehabilitation

2017 ◽  
Vol 63 (2) ◽  
pp. 193-196
Author(s):  
Fayaz Khan
Keyword(s):  
Upper Limb ◽  
Brain Stimulation ◽  
Motor Rehabilitation ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
New Paradigm ◽  
Post Stroke ◽  
Non Invasive ◽  
Theta Burst

scholarly journals Determining the optimal pulse number for theta burst induced change in cortical excitability

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daniel M. McCalley ◽  
Daniel H. Lench ◽  
Jade D. Doolittle ◽  
Julia P. Imperatore ◽  
Michaela Hoffman ◽  
...  
Keyword(s):  
Cortical Excitability ◽  
Motor Evoked Potentials ◽  
Pulse Number ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Non Invasive ◽  
Subject Variability ◽  
Secondary Analyses ◽  
Effective Doses ◽  
Theta Burst

AbstractTheta-burst stimulation (TBS) is a form of non-invasive neuromodulation which is delivered in an intermittent (iTBS) or continuous (cTBS) manner. Although 600 pulses is the most common dose, the goal of these experiments was to evaluate the effect of higher per-dose pulse numbers on cortical excitability. Sixty individuals were recruited for 2 experiments. In Experiment 1, participants received 600, 1200, 1800, or sham (600) iTBS (4 visits, counterbalanced, left motor cortex, 80% active threshold). In Experiment 2, participants received 600, 1200, 1800, 3600, or sham (600) cTBS (5 visits, counterbalanced). Motor evoked potentials (MEP) were measured in 10-min increments for 60 min. For iTBS, there was a significant interaction between dose and time (F = 3.8296, p = 0.01), driven by iTBS (1200) which decreased excitability for up to 50 min (t = 3.1267, p = 0.001). For cTBS, there was no overall interaction between dose and time (F = 1.1513, p = 0.33). Relative to sham, cTBS (3600) increased excitability for up to 60 min (t = 2.0880, p = 0.04). There were no other significant effects of dose relative to sham in either experiment. Secondary analyses revealed high within and between subject variability. These results suggest that iTBS (1200) and cTBS (3600) are, respectively, the most effective doses for decreasing and increasing cortical excitability.

The potential synergism by combining external counterpulsation with intermittent theta burst stimulation in post-stroke motor function recovery

2016 ◽  
Vol 93 ◽  
pp. 140-142
Author(s):  
Weijia He ◽  
Suk-yin Stephanie Au-Yeung ◽  
Margaret Mak ◽  
Thomas Wai Hong Leung ◽  
Howan Leung ◽  
...  
Keyword(s):  
Motor Function ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
External Counterpulsation ◽  
Post Stroke ◽  
Function Recovery ◽  
Theta Burst

scholarly journals Theta Burst Stimulation in the Rehabilitation of the Upper Limb

2012 ◽  
Vol 26 (8) ◽  
pp. 976-987 ◽  
Author(s):  
Penelope Talelli ◽  
Amanda Wallace ◽  
Michelle Dileone ◽  
Damon Hoad ◽  
Binith Cheeran ◽  
...  
Keyword(s):  
Upper Limb ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Theta Burst

scholarly journals Augmented Efficacy of Intermittent Theta Burst Stimulation on the Virtual Reality-based Cycling Training for Upper Limb Function in Patients With Stroke

2020 ◽  
Author(s):  
Yu-Hsin Chen ◽  
Chia-Ling Chen ◽  
Ying-Zu Huang ◽  
Hsieh-Ching Chen ◽  
Chung-Yao Chen ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Upper Extremity ◽  
Motor Function ◽  
Upper Limb ◽  
Manual Dexterity ◽  
Therapeutic Effects ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Theta Burst ◽  
Cycling Training

Abstract Background: Virtual reality and arm cycling have been reported as effective treatment to improve upper limb motor recovery in patients with stroke. Intermittent theta burst stimulation (iTBS) can increase ipsilesional cortical excitability, and has been increasingly used in patients with stroke. However, few studies examined the augmented effect of iTBS on neurorehabilitation program. In this study, we investigated the augmented effect of iTBS on virtual reality-based cycling training (VCT) for upper limb motor function in patients with stroke.Methods: In this randomized controlled trial, 23 patients with stroke were recruited. Each patient received either 15 sessions of iTBS or sham stimulation in addition to VCT on the same day. Outcome measures, including Modified Ashworth Scale Upper Extremity (MAS-UE), Fugl-Meyer Assessment Upper Extremity (FMA-UE) for body function, Action Research Arm Test (ARAT), Nine Hole Peg Test (NHPT), Box and Block Test (BBT) and Motor Activity Log (MAL) for activity and Stroke Impact Scale (SIS) for participation were assessed before and after the intervention. Paired t test was performed to evaluate the effectiveness after the intervention and analysis of covariance (ANCOVA) was conducted to compare the therapeutic effects between two groups.Results: At post-treatment, both groups showed significant improvement in FMA-UE and ARAT, while only the iTBS group demonstrated significant improvement in MAS-UE, BBT, NHPT, MAL and SIS. ANCOVA revealed that the iTBS group presented greater improvement than the sham group significantly in MAS-UE, NHPT and SIS, and with borderline significance in ARAT, BBT and MAL. There was no significant difference in FMA-UE between groups.Conclusions: Intermittent TBS showed augmented efficacy on VCT for reducing spasticity, improving gross motor function and manual dexterity, and increasing participation in daily life in stroke patients. This study provided an integrated innovative intervention, which may be a promising therapy to improve upper limb motor function recovery, especially manual dexterity, in stroke rehabilitation. However, this study has a small sample size, and thus a further larger-scale study is warranted to confirm the treatment efficacy.Trial registration: This trial was registered under ClinicalTrials.gov ID No. NCT03350087, retrospectively registered, on November 22, 2017.

scholarly journals Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults: systematic review and network meta-analysis

BMJ ◽  
2019 ◽  
pp. l1079 ◽  
Author(s):  
Julian Mutz ◽  
Vijeinika Vipulananthan ◽  
Ben Carter ◽  
René Hurlemann ◽  
Cynthia H Y Fu ◽  
...  
Keyword(s):  
Brain Stimulation ◽  
Meta Analysis ◽  
High Dose ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Major Depressive ◽  
Magnetic Seizure Therapy ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Theta Burst

AbstractObjectiveTo estimate the comparative clinical efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults.DesignSystematic review with pairwise and network meta-analysis.Data sourcesElectronic search of Embase, PubMed/Medline, and PsycINFO up to 8 May 2018, supplemented by manual searches of bibliographies of several reviews (published between 2009 and 2018) and included trials.Eligibility criteria for selecting studiesClinical trials with random allocation to electroconvulsive therapy (ECT), transcranial magnetic stimulation (repetitive (rTMS), accelerated, priming, deep, and synchronised), theta burst stimulation, magnetic seizure therapy, transcranial direct current stimulation (tDCS), or sham therapy.Main outcome measuresPrimary outcomes were response (efficacy) and all cause discontinuation (discontinuation of treatment for any reason) (acceptability), presented as odds ratios with 95% confidence intervals. Remission and continuous depression severity scores after treatment were also examined.Results113 trials (262 treatment arms) that randomised 6750 patients (mean age 47.9 years; 59% women) with major depressive disorder or bipolar depression met the inclusion criteria. The most studied treatment comparisons were high frequency left rTMS and tDCS versus sham therapy, whereas recent treatments remain understudied. The quality of the evidence was typically of low or unclear risk of bias (94 out of 113 trials, 83%) and the precision of summary estimates for treatment effect varied considerably. In network meta-analysis, 10 out of 18 treatment strategies were associated with higher response compared with sham therapy: bitemporal ECT (summary odds ratio 8.91, 95% confidence interval 2.57 to 30.91), high dose right unilateral ECT (7.27, 1.90 to 27.78), priming transcranial magnetic stimulation (6.02, 2.21 to 16.38), magnetic seizure therapy (5.55, 1.06 to 28.99), bilateral rTMS (4.92, 2.93 to 8.25), bilateral theta burst stimulation (4.44, 1.47 to 13.41), low frequency right rTMS (3.65, 2.13 to 6.24), intermittent theta burst stimulation (3.20, 1.45 to 7.08), high frequency left rTMS (3.17, 2.29 to 4.37), and tDCS (2.65, 1.55 to 4.55). Network meta-analytic estimates of active interventions contrasted with another active treatment indicated that bitemporal ECT and high dose right unilateral ECT were associated with increased response. All treatment strategies were at least as acceptable as sham therapy.ConclusionsThese findings provide evidence for the consideration of non-surgical brain stimulation techniques as alternative or add-on treatments for adults with major depressive episodes. These findings also highlight important research priorities in the specialty of brain stimulation, such as the need for further well designed randomised controlled trials comparing novel treatments, and sham controlled trials investigating magnetic seizure therapy.

scholarly journals Effects of priming intermittent theta burst stimulation on upper limb motor recovery after stroke: study protocol for a proof-of-concept randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e035348
Author(s):  
Jack Jiaqi Zhang ◽  
Kenneth N K Fong
Keyword(s):  
Randomised Controlled Trial ◽  
Upper Limb ◽  
Primary Motor Cortex ◽  
Controlled Trial ◽  
Sample Size Calculation ◽  
Facilitatory Effect ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Randomised Controlled ◽  
Theta Burst

IntroductionIntermittent theta burst stimulation (iTBS), a form of repetitive transcranial magnetic stimulation (rTMS), delivered to the ipsilesional primary motor cortex (M1), appears to enhance the brain’s response to rehabilitative training in patients with stroke. However, its clinical utility is highly subject to variability in different protocols. New evidence has reported that preceding iTBS, with continuous theta burst stimulation (cTBS) may stabilise and even boost the facilitatory effect of iTBS on the stimulated M1, via metaplasticity. The aim of this study is to investigate the effects of iTBS primed with cTBS (ie, priming iTBS), in addition to robot-assisted training (RAT), on the improvement of the hemiparetic upper limb functions of stroke patients and to explore potential sensorimotor neuroplasticity using electroencephalography (EEG).Methods and analysisA three-arm, subjects and assessors-blinded, randomised controlled trial will be performed with patients with chronic stroke. An estimated sample of 36 patients will be needed based on the prior sample size calculation. All participants will be randomly allocated to receive 10 sessions of rTMS with different TBS protocols (cTBS+iTBS, sham cTBS+iTBS and sham cTBS+sham iTBS), three to five sessions per week, for 2–3 weeks. All participants will receive 60 min of RAT after each stimulation session. Primary outcomes will be assessed using Fugl-Meyer Assessment-Upper Extremity scores and Action Research Arm Test. Secondary outcomes will be assessed using kinematic outcomes generated during RAT and EEG.Ethics and disseminationEthical approval has been obtained from The Human Subjects Ethics Sub-committee, University Research Committee of The Hong Kong Polytechnic University (reference number: HSEARS20190718003). The results yielded from this study will be presented at international conferences and sent to a peer-review journal to be considered for publication.Trial registration numberNCT04034069.

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