Bilateral theta burst stimulation aids neural repair and recovery after ischaemic stroke in primates

Ischaemic stroke is one of the leading causes of disability and death worldwide, yet effective treatment options remain limited. Bilateral hemisphere theta burst stimulation (TBS), a non-invasive brain stimulation technique, has shown considerable therapeutic potential in stroke; however, relevant research is still limited, and the specific mechanisms remain unclear. This study used a middle cerebral artery occlusion (MCAO) model in non-human primates to explore the application of bilateral hemispheric TBS in stroke rehabilitation. By integrating behavioural assessments, electrophysiology, functional MRI, diffusion tensor imaging and proteomics, the study evaluated the effects of TBS on neural repair, functional recovery and brain region remodelling. TBS significantly improved upper limb function after MCAO, regulated cortical excitability imbalance, enhanced neural conduction efficiency, and showed notable improvements in functional connectivity and white matter repair across multiple brain regions. Proteomic analysis further revealed the potential roles of TBS in neurorepair, metabolic regulation and anti-inflammatory effects. Additionally, large-scale genetic analysis indicated that ischaemic stroke may alter white matter structure by affecting blood proteins, and TBS intervention may help reverse these blood protein changes, thereby promoting white matter repair. These findings provide new insights for optimizing stroke treatment strategies. TBS promotes functional recovery by enhancing neuroplasticity.