High-frequency versus theta burst transcranial magnetic stimulation for the treatment of poststroke cognitive impairment in humans

High-frequency versus theta burst transcranial magnetic stimulation for the treatment of poststroke cognitive impairment in humans

J Psychiatry Neurosci 2020;45(4):262-270 | PDF

Po-Yi Tsai, MD; Wang-Sheng Lin, MD; Kun-Ting Tsai, MD; Chia-Yu Kuo, MD; Pei-Hsin Lin, MD

Background: Because the reliability of repetitive transcranial magnetic stimulation (rTMS) in treating poststroke cognitive impairment has not been convincingly demonstrated, we systematically examined the effectiveness of this regimen with 2 protocols.

Methods: We randomly allocated 41 patients with poststroke cognitive impairment to receive 5 Hz rTMS (n = 11), intermittent theta burst stimulation (iTBS; n = 15) or sham stimulation (n = 15). Each group received 10 stimulation sessions over the left dorsolateral prefrontal cortex. We performed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Beck Depression Inventory at baseline and after the intervention.

Results: The 5 Hz rTMS group showed significantly greater improvement than the sham group in RBANS total score (p = 0.006), attention (p = 0.001) and delayed memory (p < 0.001). The iTBS group showed significantly greater improvement than the sham group in RBANS total score (p = 0.005) and delayed memory (p = 0.007). The 5 Hz rTMS group exhibited a superior modulating effect in attention compared to the iTBS group (p = 0.016). Patients without comorbid hypertension (p = 0.008) were predisposed to favourable therapeutic outcomes.

Limitations: Although we included only patients with left hemispheric stroke, heterogeneity associated with cortical and subcortical implications existed. We did not investigate the remote effects of rTMS.

Conclusion: Our results demonstrated that both 5 Hz rTMS and iTBS were effective for poststroke cognitive impairment in terms of global cognition, attention and memory function; the domain of attention was susceptible to 5 Hz modulation. Treatment with 5 Hz rTMS may slow cognitive decline, representing both a pivotal process in poststroke cognitive impairment and an aspect of neuroplasticity that contributes to disease-modifying strategies.

Clinical trial registration: NCT02006615; clinicaltrials.gov/ct2/show/NCT02006615.


Submitted Mar. 17, 2019; Revised July 25, 2019; Accepted Sep. 15, 2019; Published online Mar. 11, 2020

Acknowledgments: The authors thank Hsin-Yi Huang for her contribution to this research.

Affiliations: From the Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan (Tsai, Tsai, Kuo); the National Yang-Ming University, School of Medicine, Taipei, Taiwan (Tsai, W. Lin); the Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (W. Lin, P. Lin).

Funding: This work was supported by the Taipei Veterans General Hospital Grant (V104C058).

Competing interests: None declared.

Contributors: P. Tsai designed the study. W. Lin, C. Kao, K. Tsai and P. Lin acquired the data, which P. Tsai and P. Lin analyzed. P. Tsai, C. Kao and K. Tsai wrote the article, which W. Lin, K. Tsai, and P. Lin reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.

DOI: 10.1503/jpn.190060

Correspondence to: P.-Y. Tsai, Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; pytsai@vghtpe.gov.tw