BACKGROUND Both 1 Hz repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) are reported to benefit upper limb motor function rehabilitation in patients with stroke. However, the efficacy of combining 1 Hz rTMS and iTBS has not been adequately explored. OBJECTIVE We aimed to compare the effects of 1 Hz rTMS and the combination of 1 Hz rTMS and iTBS on the upper limb motor function in the subacute phase post-stroke. METHODS Twenty-eight participants were randomly assigned to three groups: Group A (1 Hz rTMS over the contralesional primary motor cortex (M1) and iTBS over the ipsilesional M1), Group B (contralesional 1 Hz rTMS and ipsilesional sham iTBS), and Group C (contralesional sham 1 Hz rTMS and ipsilesional sham iTBS). The participants received the same conventional rehabilitation accompanied by sessions of transcranial magnetic stimulation for two weeks (5 days one week). Motor-evoked potential (MEP), upper extremity Fugl-Meyer Assessment (UE-FMA), and Barthel Index (BI) were performed before and after the sessions. RESULTS Group A showed greater UE-FMA, BI, and MEP amplitude improvement and more significant decrement in MEP latency compared to Group B and Group C in testable patients. Correlation analyses in Group A revealed a close relation between ipsilesional MEP amplitude increment and UE-FMA gain. CONCLUSIONS The combining of 1 Hz rTMS and iTBS protocol in the present study is tolerable and more beneficial for motor improvement than the single use of 1 Hz rTMS in patients with subacute stroke.

中文翻译：

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亚急性脑卒中患者间歇性theta-burst刺激和1 Hz重复经颅磁刺激的结合以增强上肢运动恢复的功效：一项随机对照试验。

背景技术据报道，无论是1 Hz重复经颅磁刺激（rTMS）还是间歇性theta-burst刺激（iTBS）都有助于中风患者的上肢运动功能康复。但是，尚未充分探索结合1 Hz rTMS和iTBS的功效。目的我们旨在比较1 Hz rTMS以及1 Hz rTMS和iTBS的组合对亚急性期卒中后上肢运动功能的影响。方法将28名参与者随机分为三组：A组（对侧主运动皮层（M1）上为1 Hz rTMS，同侧M1上为iTBS），B组（对侧1 Hz rTMS和同侧假iTBS）和B组C（腹腔假手术1 Hz rTMS和同侧假手术iTBS）。参与者接受了相同的常规康复治疗，并进行了两周（一周5天）的经颅磁刺激治疗。在运动前和运动后进行运动诱发电位（MEP），上肢Fugl-Meyer评估（UE-FMA）和Barthel指数（BI）。结果与可测试患者相比，与B组和C组相比，A组显示出更大的UE-FMA，BI和MEP幅度改善，以及MEP潜伏期显着减少。A组的相关性分析显示同病MEP振幅增量与UE-FMA增益之间存在密切关系。结论在亚急性卒中患者中，将1 Hz rTMS和iTBS方案相结合可耐受并且比单次使用1 Hz rTMS更有利于运动改善。