Stroke Clinical Trial
Official title:
Development and Efficacy Evaluation of Individualized rTMS Protocol for Stroke Recovery
This study aims to develop individualized therapeutic protocol to improve stroke recovery and fits the scheme of Mechanisms, biomarkers, and treatment strategies for stroke, aging, and Parkinson's disease by advanced EEG analysis and transcranial magnetic stimulation technique.
It has long been a challenge to promote the recovery after stroke. So far, rehabilitation has
been the most evident way for this purpose, while pharmacological approaches have done very
little.
However, the unsatisfied results urge us to recognize the need of new therapeutic solutions
for stroke recovery. In the past few years, the development of non-invasive brain stimulation
techniques, which are capable of altering the brain excitability through plasticity-like
mechanisms for up to an hour or so, lead to the expectation of improving the recovery of
stroke and other neurological disorders by manipulation neuroplasticity. Nevertheless, even
with the help of brain stimulation, the results in stroke recovery are diverse and limited,
although most studies agree that non-invasive brain stimulation, including repetitive
transcranial magnetic stimulation (rTMS) is beneficial to the recovery after stroke.
Therefore, it is an important topic to ameliorate the recipe of brain stimulation for stroke
recovery to improve its efficiency and efficacy. Facing this challenge, the investigators
designed this study to develop individualized rTMS protocol for stroke recovery, to verify
the predictor of stroke outcome discovered by DCM and to explore factors that cause the
variability of rTMS. Based on our recent findings that revealed key patterns of stroke
recovery base in EEG-based EEG based dynamic causal modelling (DCM), the individualize TMS
protocol will be developed. The investigators will first apply different protocols of rTMS
given to a variety of locations within the motor network to evaluate their effects on the DCM
network. The results will be used for selecting proper rTMS protocols for stroke patients
based on their DCM results. The effect of the individualized rTMS protocol will be tested in
a small group of patient first. Then the longer therapeutic effect of the protocol will be
assessed in a larger patient group under a double-blinded randomized control basis. With the
help of this project, the investigators will be able to understand how different protocols of
rTMS given to a variety of locations within the motor network affect the DCM network. Such
information will be useful for developing individualized rTMS protocol for not only stroke
therapy in the present study, but also other neurological disorders, e.g. Parkinson's disease
and dystonia, in the further studies.
Furthermore, the investigators expect that the patients stimulated with rTMS using the
protocol matched to their DCM network will recover better than those treated with unmatched
protocol. This part of result could be further applied as a clinical application to
facilitate stroke recovery. The predictors for stroke recovery revealed by the DCM model will
also be verified in the current project. This will give us more information about the
accuracy of the predictors and may give us new insights for the further development of stroke
therapy. The investigators will further analyze EEG data and the results to provide knowledge
of the state-dependent effect of brain on the variability of the current forms of rTMS and
other noninvasive brain stimulation. This part of information will be very helpful for
developing the strategy for eliminating the variability of rTMS and for improving the
protocol of rTMS to be more powerful and efficient.
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