Department of Rehabilitation Sciences, 26680 The Hong Kong Polytechnic University , Hong Kong SAR, China.
Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
Rev Neurosci. 2024 Apr 29;35(6):679-695. doi: 10.1515/revneuro-2024-0030. Print 2024 Aug 27.
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 = 0.646, = 0.003) and functional activity (Hedge's = 0.500, < 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 ( = 0.015) and functional activity ( = 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 ( = 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.
本系统评价旨在评估不同 theta 爆发刺激（TBS）方案对改善脑卒中患者上肢运动功能的效果，及其相关疗效调节剂和潜在的神经机制。我们对 2000 年 1 月 1 日至 2023 年 8 月 29 日期间发表的 29 项对照试验进行了荟萃分析，这些试验研究了 TBS 对脑卒中后患者上肢运动、神经生理学和神经影像学结果的影响。与对照组相比，TBS 显著改善了上肢运动障碍（Hedge's = 0.646， = 0.003）和功能活动（Hedge's = 0.500， < 0.001）。元回归显示，皮质下卒中患者的比例与运动障碍（ = 0.015）和功能活动（ = 0.018）的效应大小之间存在显著关系。亚组分析显示，使用 600 脉冲和 1200 脉冲 TBS 的研究之间，上肢运动障碍改善程度存在显著差异（ = 0.002）。神经生理学研究一致表明，间歇性 TBS 增加了同侧皮质运动兴奋性。然而，连续 TBS 的区域效应以及 TBS 的远程和网络效应的证据仍然存在分歧，且相对不足。总之，TBS 有效增强了脑卒中后的上肢运动功能。皮质保留的患者可能对 TBS 反应更好。与传统的 600 脉冲方案相比，新型 TBS 方案采用更高剂量可能会带来更好的疗效。TBS 促进脑卒中后恢复的机制主要归因于皮质运动兴奋性的调节，可能是由于募集了与同侧运动皮质相连的皮质运动网络。
