Therapeutics
Yang Liu, MS
Physician
Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai, Shanghai, China (People's Republic)
Jieshi HE, PhD
Researcher
Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
Shanghai, Shanghai, China (People's Republic)
Ying WANG, PhD
Researcher
Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China
Shanghai, Shanghai, China (People's Republic)
Zhiwei XU, MS
Researcher
Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China
Shanghai, Shanghai, China (People's Republic)
Qiuxu LIU, PhD
Researcher
Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China
Shanghai, Shanghai, China (People's Republic)
Mu-ming POO, PhD
Director, Senior Investigator
Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China
Shanghai, Shanghai, China (People's Republic)
Qing XIE, MD
Chief Physician
Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
Shanghai, Shanghai, China (People's Republic)
Jixian WANG, MD
Associate Chief Physician
Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
Shanghai, Shanghai, China (People's Republic)
Traditional rTMS shows limited efficacy in stroke patients lacking motor-evoked potentials (MEPs). This case evaluates a novel approach combining real-time motor task-synchronized rTMS with neuroimaging-guided targeting to improve upper limb function, focusing on pinch strength.
Case Description:
We reported a 57-year-old male with subacute ischemic stroke and left hemiplegia who underwent 10 sessions of treatment with 5 Hz rTMS that was synchronized with the performance of a upper limb motor task. Multimodal MRI was used to optimize the rTMS coil placement. Clinical motor assessments (FMA-UE, ARAT, Brunnstrom Recovery Stage) and neurophysiological measures (MEP, resting-state fMRI functional connectivity) were performed during the pre-treatment (T1), post-treatment (T2), and 1-month follow-up (F1) periods. Motor trajectories and sEMG were assessed at T1 and T2.
Discussions:
The patient demonstrated marked improvements: FMA-UE score increased from 46 to 52 (+13.0%), ARAT from 33 to 49 (+48.5%), and Brunnstrom Recovery Stage (BRS) of hand progressed from V to VI. Notably, the pinch subscale of ARAT increased from 0 to 12. MEPs emerged in the M1 of affected hemisphere after rTMS treatment, along with restored resting-state functional connectivity between the ipsilesional sensorimotor and contralesional motor cortices. Sleep quality (PSQI = 2) and daily functioning (Modified Barthel Index = 81) remained stable. Kinematic analysis revealed reduced task completion time and improved movement smoothness after treatment. sEMG analysis demonstrated increased RMS value and reorganization of muscle coordination patterns. Resting fMRI showed marked enhancement with the affected M1-to-S1 functional connectivity increasing by 21.3% (0.47 to 0.57) and the affected M1-to-the unaffected M1 connectivity by 22.4% (0.67 to 0.82).
Conclusions:
Task-synchronized precision rTMS promoted meaningful upper limb recovery in an MEP-negative stroke patient, particularly enhancing pinch function, likely by potentiating task-relevant neural circuits through synchronized stimulation.
