Effects of Transcranial Magnetic Stimulation on Patients of Poststroke Upper Extremity Motor Impairment: A Randomized, Controlled Trial

Abstract Objective This study compared the effects of continuous theta burst stimulation (cTBS) and low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) on cortical activity modulation and upper limb motor recovery in subacute stroke patients. Design A total of 105 subacute stroke patients with unilateral upper limb impairment were randomly divided into three groups: cTBS, LF-rTMS, and sham. Main outcomes included Fugl-Meyer Assessment (UEFM) and modified Barthel Index (MBI) scores at baseline, 4 weeks (post-treatment), and 12 weeks (follow-up). Secondary outcomes evaluated cortical activation via functional near-infrared spectroscopy (fNIRS). Results Among 103 recruited participants, 98 completed follow-up. Both cTBS and LF-rTMS groups showed significantly greater UEFM improvement than the sham group at 4 and 12 weeks (P < 0.05), while MBI scores did not differ significantly. fNIRS revealed that active treatments suppressed contralesional primary motor cortex activation, with cTBS additionally inhibiting premotor and supplementary motor areas. Conclusion cTBS and LF-rTMS effectively enhanced upper limb motor motricity in stroke patients compared to sham stimulation, suggesting their potential as non-invasive neuromodulatory therapies for post-stroke rehabilitation.