The effects of combined high-frequency repetitive transcranial magnetic stimulation and cervical nerve root magnetic stimulation on upper extremity motor recovery following stroke

Xiaofang Wu; Rui Wang; Qunqiang Wu; Chunhua Liao; Jianshe Zhang; Huiduo Jiao; Baolin Chen; Shuyan Wang; Rui Liu

doi:10.3389/fnins.2023.1100464

The effects of combined high-frequency repetitive transcranial magnetic stimulation and cervical nerve root magnetic stimulation on upper extremity motor recovery following stroke

Front Neurosci. 2023 Feb 7:17:1100464. doi: 10.3389/fnins.2023.1100464. eCollection 2023.

Authors

Xiaofang Wu^{1

2}, Rui Wang³, Qunqiang Wu¹, Chunhua Liao¹, Jianshe Zhang¹, Huiduo Jiao¹, Baolin Chen¹, Shuyan Wang¹, Rui Liu¹

Affiliations

¹ Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi'an, China.
² Graduate School of Xi'an Medical College, Xi'an, China.
³ Medical Department of Tangdu Hospital, Air Force Medical University, Xi'an, China.

Abstract

Introduction: Upper limb motor impairments after stroke cause patients partial or total loss of the capability of performing daily living, working, and social activities, which significantly affects the quality of life (QoL) of patients and brings a heavy burden to their families and society. As a non-invasive neuromodulation technique, transcranial magnetic stimulation (TMS) can act not only on the cerebral cortex, but also on peripheral nerves, nerve roots, and muscle tissues. Previous studies have shown that magnetic stimulation on the cerebral cortex and peripheral tissues has a positive effect on the recovery of upper limb motor function after stroke, however, few studies have reported the combination of the two.

Objective: This study was to investigate whether high frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with cervical nerve root magnetic stimulation more effectively ameliorates upper limb motor function in stroke patients. We hypothesized that the combination of the two can achieve a synergistic effect and further promotes functional recovery.

Methods: Sixty patients with stroke were randomly divided into four groups and received real or sham rTMS stimulation and cervical nerve root magnetic stimulation consecutively before other therapies, once daily over five fractions per week for a total of 15 times. We evaluated the upper limb motor function and activities of daily living of the patients at the time of pre-treatment, post-treatment, and 3-month follow up.

Results: All patients completed study procedures without any adverse effects. The upper limb motor function and activities of daily living improved in patients of each group were improved after treatment (post 1) and 3 months after treatment (post 2). Combination treatment was significantly better than single treatments alone or sham.

Conclusion: Both rTMS and cervical nerve root magnetic stimulation effectively promoted upper limb motor recovery in patients with stroke. The protocol combining the two is more beneficial for motor improvement and patients can easily tolerate it.

Clinical trial registration: https://www.chictr.org.cn/, identifier ChiCTR2100048558.

Keywords: cervical nerve root; rehabilitation; repetitive transcranial magnetic stimulation; stroke; upper limb motor function.

Grants and funding

This work was supported by grants from the National Natural Science Foundation of China (No. 81771469) and Key basic research projects of basic strengthening plan (No. FK2022030029). The funding body had no role in the design of the study, data collection, analysis, and interpretation and in writing the manuscript.