600 Section - Effects of Focal Shock Wave Therapy on Cortical Electrical Activity in a Hemiplegic Patient Post-Ischemic Stroke: A Case Report

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Co-Author(s)

MN

Morgana H. A. Navas, MD

Medical Resident
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
São Paulo, Sao Paulo, Brazil
GJ

Guilherme S. C. Julien, MD

Medical Resident
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
São Paulo, Sao Paulo, Brazil

Presenting Author/Autor expositor(s)

AS

André T. Sugawara, PhD

Associate Professor
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
São Paulo, Sao Paulo, Brazil

Case Diagnosis:

A 44-year-old hypertensive male presented with complete left hemiplegia secondary to an ischemic stroke caused by right internal carotid artery dissection in October 2022. After three years, he remained in the maintenance phase of rehabilitation, with persistent brachial spasticity and stable motor deficits.

Case Description: While awaiting a new botulinum toxin injection, the patient underwent a non-pharmacological intervention for spasticity using focused extracorporeal shock wave therapy (FESWT) applied to the palmar region of the plegic hand (4,000 pulses; 0.10 - 0.25 mJ; 10 Hz). To investigate potential cortical effects, a high-density electroencephalogram (EEG) was performed immediately before and after FESWT, with analysis by sLORETA. Motor (C3, C4) and occipital (O1, O2) areas were evaluated, along with interhemispheric functional connectivity.

Discussions: Post-FESWT EEG revealed increased cortical activity in the motor area of the lesioned hemisphere (C4) across all frequency bands, with prominent changes in Delta, Alpha, and Beta rhythms. The preserved motor area (C3) showed an even greater increase, particularly in fast-frequency bands, compatible with synaptic potentiation. Conversely, a bilateral reduction in occipital Alpha tone (O1, O2) was observed - more pronounced in the preserved hemisphere - resulting in improved interhemispheric balance. Three-dimensional sLORETA reconstructions supported these findings. Functional connectivity analysis demonstrated a marked increase in interhemispheric hyperconnections in Alpha 1, Alpha 2, and Beta 2 bands. Collectively, these results suggest adaptive cortical reorganization and potential centrally mediated neuromodulatory effects triggered by a peripheral focal stimulus, a mechanism not previously described for FESWT.

Conclusions: Peripheral application of FESWT to the plegic hand of a post-ischemic stroke patient produced measurable cortical changes, including increased motor excitability, occipital modulation, and enhanced interhemispheric connectivity. These findings highlight the potential of FESWT as a non-invasive neuromodulatory intervention, suggesting central effects beyond its established peripheral benefits. This case expands therapeutic perspectives for post-stroke rehabilitation.