Theta burst stimulation: what role does it play in stroke rehabilitation? A systematic review of the existing evidence

Jiang, Tingting; Wei, Xiupan; Wang, Mingzhu; Xu, Jiang; Xia, Nan; Lu, Min

doi:10.1186/s12883-023-03492-0

Table 1 Main characteristics of studies included in the systematic review (n = 33)

From: Theta burst stimulation: what role does it play in stroke rehabilitation? A systematic review of the existing evidence

Clinical feature	Group	Sample size(Male/Female)	Age (years)	Side(Left/Right)	Type (Ischemic/ Hemorrhagic)	Course of disease	TBS protocol	Targeted Area	Outcomes	Follow-up	Adjuvant therapy	Adverse effects (n)
Cognitive impairment
Li et al.[18]	iTBS	16/12	69.50 ± 9.50	16/12	18/10	25.00 d	600 pulses, 100% RMT, 1 sess/d, 2 weeks	LH DLPFC	MMSE, OCS	/	Conventional rehabilitation therapies	sneezing: 1
Li et al.[18]	sham	18/12	66.00 ± 13.00	24/6	14/16	25.00 d	600 pulses, 100% RMT, 1 sess/d, 2 weeks	LH DLPFC	MMSE, OCS	/	Conventional rehabilitation therapies	/
Chu et al.[19]	iTBS	18/3	57.24 ± 14.03	12/9	13/8	4.00 ± 5.00 mon	600 pulses, 70% RMT, 1 sess/d, 6 weeks	LH DLPFC	MMSE, LOTCA,	/	Computer- assisted rehabilitation therapy	/
Chu et al.[19]	sham	13/7	66.75 ± 12.23	13/7	12/8	6.00 ± 4.00 mon	600 pulses, 70% RMT, 1 sess/d, 6 weeks	LH DLPFC	MMSE, LOTCA,	/	Computer- assisted rehabilitation therapy	/
Tsai et al.[17]	iTBS	11/4	60.13 ± 14.10	Left	7/8	18.47 ± 20.21 d	600 pulses, 80% RMT, 1 sess/d, 2 weeks	LH DLPFC	RBANS	/	N/A	/
Tsai et al.[17]	sham	13/2	56.23 ± 12.00	Left	10/5	38.00 ± 7.90 d	600 pulses, 80% RMT, 1 sess/d, 2 weeks	LH DLPFC	RBANS	/	N/A	/
Visuospatial neglect
Koch et al.[21]	cTBS	N/A	61.40 ± 13.02	Right	Ischemic	46.80 d	600 pulses, 80% AMT, 2 sess/d, 2 weeks	LH PPC	BIT	2 weeks	Computer- assisted rehabilitation therapy	/
Koch et al.[21]	sham	N/A	71.89 ± 4.86	Right	Ischemic	36.90 d	600 pulses, 80% AMT, 2 sess/d, 2 weeks	LH PPC	BIT	2 weeks	Computer- assisted rehabilitation therapy	/
Fu et al.[11]	cTBS	8/2	55.10 ± 13.96	Right	5/5	43.70 ± 23.50 d	801 pulses, 80% RMT, 4 sess/d, 14 days	LH PPC	SCT, LBT	4 weeks	Conventional rehabilitation therapies	slight dizziness: 2
Fu et al.[11]	sham	8/2	59.50 ± 12.68	Right	5/5	59.50 ± 12.00 d	801 pulses, 80% RMT, 4 sess/d, 14 days	LH PPC	SCT, LBT	4 weeks	Conventional rehabilitation therapies	/
Yang et al.[9]	cTBS	5/4	49.45 ± 10.78	N/A	6/3	104.85 ± 36.38 d	801 pulses, 80% RMT, 4 sess/d, 2 weeks	LH PPC	SCT, LBT	1 mon	Conventional rehabilitation therapies	N/A
Yang et al.[9]	sham	3/7	47.70 ± 11.81	N/A	6/4	105.91 ± 37.59 d	801 pulses, 80% RMT, 4 sess/d, 2 weeks	LH PPC	SCT, LBT	1 mon	Conventional rehabilitation therapies	N/A
Fu et al.[22]	cTBS	9/3	60.17 ± 14.05	Right	N/A	41.83 ± 20.56 d	600 pulses, 80% RMT, 4sess/day, 10 days	LH PPC	SCT, LBT	/	Conventional rehabilitation therapies	/
Fu et al.[22]	control	9/3	62.00 ± 9.78	Right	N/A	36.17 ± 17.50 d	600 pulses, 40% RMT, 4 sess/day, 10 days	LH PPC	SCT, LBT	/	Conventional rehabilitation therapies	/
Cao et al.[20]	iTBS	6/1	55.00 ± 12.00	Right	N/A	32.00 ± 17.00 d	600 pulses, 80% RMT, 2 sess/day, 2 weeks	LH DLPFC	SCT, LBT	/	Conventional rehabilitation therapies	N/A
Cao et al.[20]	control	5/1	62.00 ± 10.00	Right	N/A	36.00 ± 17.00 d	600 pulses, 40% RMT, 2 sess/day, 2 weeks	LH DLPFC	SCT, LBT	/	Conventional rehabilitation therapies	N/A
Nyffeler et al.[13]	8cTBS	5/5	67.80 ± 10.13	Right	N/A	26.80 ± 20.89 d	801 pulses, 100% RMT, 4sess/day, 2 days	LH PPC	CBS	3 mons	Conventional rehabilitation therapies	/
	16cTBS	6/4	74.30 ± 10.23		N/A	22.90 ± 10.34 d	801 pulses, 100% RMT, 4 sess/day, 4 days
	sham	7/3	70.60 ± 11.44		N/A	25.80 ± 11.26 d	801 pulses, 100% RMT, 4sess/day, 2 days
Hopfner et al.[10]	cTBS	5/7	62.00 ± 10.60	Right	N/A	32.42 ± 11.95 d	801 pulses, 100% AMT, 2 sess/day, 2 weeks	LH PPC	BCT	/	Smooth pursuit training	N/A
Hopfner et al.[10]	sham	4/2	65.40 ± 15.20	Right	N/A	32.42 ± 11.95 d	801 pulses, 100% AMT, 2 sess/day, 2 weeks	LH PPC	BCT	/	Smooth pursuit training	N/A
Vatanparasti et al.[12]	cTBS	5/2	67.50 ± 8.40	N/A	4/3	N/A	801 pulses, 80% RMT, 1 sess/day, 2 weeks	LH PPC	SCT, LBT	/	Prism adaptation	/
Vatanparasti et al.[12]	sham	5/2	65.50 ± 10.20	N/A	4/3	N/A	801 pulses, 80% RMT, 1 sess/day, 2 weeks	LH PPC	SCT, LBT	/	Prism adaptation	/
Aphasia
Chou et al.[26]	iTBS	15/14	62.70 ± 12.70	Left	20/9	17.60 ± 20.80 mon	600 pulses, 80% RMT, 1 sess/day, 2 weeks	LH IFG	CCAT	/	Speech and language therapy	/
Chou et al.[26]	sham	20/9	61.60 ± 14.70	Left	20/9	16.50 ± 24.60 mon	600 pulses, 80% RMT, 1 sess/day, 2 weeks	LH IFG	CCAT	/	Speech and language therapy	/
Allendorfer et al.[24]	iTBS	12/6	59.61 ± 10.54	Left	Ischemic	4.62 ± 4.17 y	600 pulses, 80% AMT, 1 sess/day, 3 weeks	LH IFG	BNT,SFT,COWAT, WAB-R AQ,PPVT,	3 mons	N/A	N/A
Allendorfer et al.[24]	Sham	4/2	43.78 ± 13.98	Left	Ischemic	3.94 ± 3.56 y	600 pulses, 80% AMT, 1 sess/day, 3 weeks	LH IFG	BNT,SFT,COWAT, WAB-R AQ,PPVT,	3 mons	N/A	N/A
Szaflarski et al.[25]	iTBS	14/7	59.39 ± 13.83	Left	Ischemic	3.90 ± 4.02 y	600 pulses, 80% AMT, 1 sess/day, 3 weeks	LH IFG	BNT,SFT,COWAT, WAB	3 mons	N/A	N/A
Szaflarski et al.[25]	sham	4/2	48.78 ± 11.34	Left	Ischemic	4.62 ± 4.02 y	600 pulses, 80% AMT, 1 sess/day, 3 weeks	LH IFG	BNT,SFT,COWAT, WAB	3 mons	N/A	N/A
Zheng et al.[23]	cTBS	13/2	53.13 ± 11.26	Left	N/A	42.80 ± 12.91 d	600 pulses, 80% AMT, 1 sess/day, 3 weeks	RH pSTG	WAB-AQ	/	Speech and language therapy	N/A
Zheng et al.[23]	Sham	11/3	66.33 ± 13.77	Left	N/A	50.50 ± 21.93 d	600 pulses, 80% AMT, 1 sess/day, 3 weeks	RH pSTG	WAB-AQ	/	Speech and language therapy	N/A
Spasticity /Upper Extremity /Hand
Chen et al.[29]	iTBS	7/4	52.90 ± 11.10	6/5	2/9	> 6 mon	600 pulse, 80% AMT, 1 sess/day, 2 weeks	AH M1	MAS, FMA-UE, ARAT	/	Physical and occupational therapy	/
Chen et al.[29]	sham	7/4	52.60 ± 8.30	9/2	3/8	> 6 mon	600 pulse, 80% AMT, 1 sess/day, 2 weeks	AH M1	MAS, FMA-UE, ARAT	/	Physical and occupational therapy	/
Kuzu et al.[27]	cTBS	6/1	61.30 ± 9.80	2/5	Ischemic	14.50 ± 1.60 mon	600 pulse, 80% AMT, 1 sess/day, 2 weeks	UH M1	MAS, FMA-UE	4 weeks	Conventional rehabilitation therapies	/
Kuzu et al.[27]	sham	2/4	65.00 ± 4.60	3/3	Ischemic	14.50 ± 2.00 mon	600 pulse, 80% AMT, 1 sess/day, 2 weeks	UH M1	MAS, FMA-UE	4 weeks	Conventional rehabilitation therapies	/
Chen et al.[28]	iTBS	13/3	57.38 ± 8.04	4/12	10/6	80.13 ± 35.19 d	600 pulse, 80% AMT, 1 sess/day, 2 weeks	Ipsilesional CB	MAS	/	Physical therapy	/
Chen et al.[28]	sham	12/4	51.44 ± 9.19	9/7	8/8	101.50 ± 54.15 d	600 pulse, 80% AMT, 1 sess/day, 2 weeks	Ipsilesional CB	MAS	/	Physical therapy	/
Watanabe et al.[31]	iTBS	5/3	72.50 ± 6.50	4/4	N/A	< 1 week	600 pulses, 110%RMT, 1 sess /day, 10 days	AH M1	FMA-UE, MAS	/	Conventional rehabilitation therapies	/
Watanabe et al.[31]	sham	3/3	75.20 ± 5.50	1/5	N/A	< 1 week	600 pulses, 110%RMT, 1 sess /day, 10 days	AH M1	FMA-UE, MAS	/	Conventional rehabilitation therapies	/
Ackerley et al.[32]	iTBS	6/3	61	3/6	N/A	20 mon	600 pulses, 90% AMT, 1 sess /day, 10 days	AH M1	FMA-UE, ARAT	1 mon and 3 mons	Conventional rehabilitation therapies	/
Ackerley et al.[32]	sham	6/3	71	3/6	N/A	18 mon	600 pulses, 90% AMT, 1 sess /day, 10 days	AH M1	FMA-UE, ARAT	1 mon and 3 mons	Conventional rehabilitation therapies	/
Chen et al.[33]	iTBS	8/4	54.36 ± 10.56	7/5	6/6	5.01 ± 4.39 mon	600 pulses, 80% AMT, 2 sess/day, 15 days	AH M1	MAS, FMA-UE, ARAT, NHPT, BBT,	/	Virtual reality-based cycling training	/
Chen et al.[33]	sham	10/1	48.95 ± 9.63	7/4	2/9	7.99 ± 5.41 mon	600 pulses, 80% AMT, 2 sess/day, 15 days	AH M1	MAS, FMA-UE, ARAT, NHPT, BBT,	/	Virtual reality-based cycling training	/
Talelli et al.[38]	iTBS	7/6	54.4 ± 15.8	9/4	Ischemic	17.50 ± 5.10 mon	600 pulses, 80% AMT, 1 sess /day; 2 weeks	AH M1	NHPT, JTT, grip strength	1 mon and 3 mons	Physical therapy	/
	sham	9/3	58.5 ± 12.0	5/7		38.50 ± 57.20 mon	600 pulses, 80% AMT, 1 sess /day; 2 weeks	AH M1
	cTBS	7/5	55.8 ± 12.4	2/10		29.80 ± 19.70 mon	600 pulses, 80% AMT, 1 sess /day, 2 weeks	UH M1
	sham	6/6	59.4 ± 12.4	7/5		49.60 ± 76.90 mon	600 pulses, 80% AMT, 1 sess /day, 2 weeks	UH M1
Sung et al.[34]	iTBS	9/3	64.20 ± 11.90	N/A	8/4	8.10 ± 1.5 mon	600 pulses, 80% AMT, 10 sess/day, 4 weeks	AH M1	FMA-UE, WMFT	/	Physical therapy and occupational therapy	/
Sung et al.[34]	sham	11/3	63.10 ± 12.80	N/A	9/5	8.20 ± 1.60 mon	600 pulses, 80% AMT, 10 sess/day, 4 weeks	AH M1	FMA-UE, WMFT	/	Physical therapy and occupational therapy	/
Khan et al.[35]	TBS	13/7	63.55 ± 12.67	6/14	Ischemic	17.10 ± 4.82 d	600 pulses, 60%RMT, 1 sess /day, 4 weeks	iTBS to AH M1 + cTBS to UH M1	FMA-UE	3 mon, 6 mon and 1 y	Physical therapy	N/A
Khan et al.[35]	no sti	12/8	64.60 ± 12.99	5/15	Ischemic	16.40 ± 5.58 d	600 pulses, 60%RMT, 1 sess /day, 4 weeks	iTBS to AH M1 + cTBS to UH M1	FMA-UE	3 mon, 6 mon and 1 y	Physical therapy	N/A
Di Lazzaro et al.[37]	cTBS	3/3	59.5 ± 12.4	1/5	Ischemic	34.80 ± 17.50 mon	600 pulses, 80% AMT, 1 sess /day, 10 days	AH M1	ARAT, NHPT, JTT	1 mon and 3 mons	Physical therapy	/
Di Lazzaro et al.[37]	sham	4/2	57.5 ± 12.3	2/4	Ischemic	30.00 ± 27.60 mon	600 pulses, 80% AMT, 1 sess /day, 10 days	AH M1	ARAT, NHPT, JTT	1 mon and 3 mons	Physical therapy	/
Zhang et al.[36]	cTBS + iTBS	9/5	58.21 ± 9.00	8/6	6/8	50.57 ± 32.01 mon	600 pulses, 70% RMT, 1 sess /day, 3 weeks	AH M1	FMA-UE, ARAT	2 weeks	Robot- assisted training	N/A
	sham cTBS + iTBS	7/7	59.50 ± 8.56	8/6	8/6	63.93 ± 46.80 mon
	sham cTBS + sham iTBS	8/6	64.00 ± 5.39	7/7	10/4	50.86 ± 29.50 mon
Nicolo et al.[30]	cTBS [14]	7/7	62.40 ± 12.30	4/10	13/1	5.30 ± 1.80 weeks	600 pulses, 70% RMT, 3 sess/week, 3 weeks	UH M1	FMA-UE, NHPT	1 mon	Physical therapy	/
Nicolo et al.[30]	sham [13]	8/5	64.30 ± 17.10	3/10	10/3	4.70 ± 1.40 weeks	600 pulses, 70% RMT, 3 sess/week, 3 weeks	UH M1	FMA-UE, NHPT	1 mon	Physical therapy	/
Lower Extremity /Balance
Koch et al.[40]	iTBS	13/4	64.00 ± 11.30	6/11	Ischemic	15.18 ± 6.63 mon	600 pulse, 80% AMT, 2 sess/day, 3 weeks	ipsilesional CB	BBS, FMA-LE	3 weeks	Physical therapy	/
Koch et al.[40]	sham	10/7	64.00 ± 11.30	8/9	Ischemic	15.88 ± 6.00 mon	600 pulse, 80% AMT, 2 sess/day, 3 weeks	ipsilesional CB	BBS, FMA-LE	3 weeks	Physical therapy	/
Liao et al.[42]	iTBS	12/3	51.53 ± 9.22	11/4	7/8	70.40 ± 44.43 d	600 pulse, 80% AMT, 1 sess/day, 2 weeks	ipsilesional CB	BBS, FMA-LE	/	Physical therapy	slight headache: 1
Liao et al.[42]	sham	9/6	55.40 ± 8.10	9/6	8/7	86.53 ± 45.26 d	600 pulse, 80% AMT, 1 sess/day, 2 weeks	ipsilesional CB	BBS, FMA-LE	/	Physical therapy	/
Lin et al.[41]	iTBS	1/9	60.80 ± 8.10	5/5	7/3	359.00 ± 171.00 d	1200 pulses, 100% midline MT, 2 sess/week, 5 weeks	Bilateral M1	BBS, FMA-LE	/	Conventional rehabilitation therapies	/
Lin et al.[41]	sham	2/8	61.10 ± 9.70	6/4	9/1	384.00 ± 270.00 d	1200 pulses, 100% midline MT, 2 sess/week, 5 weeks	Bilateral M1	BBS, FMA-LE	/	Conventional rehabilitation therapies	/
Xie et al.[39]	iTBS	13/5	52.35 ± 8.62	7/11	10/8	2.22 ± 1.70 mon	600 pulse, 80% AMT, 1 sess/day, 2 weeks	contralesional CB	FMA-LE	/	Conventional rehabilitation therapies	/
Xie et al.[39]	sham	11/7	54.41 ± 7.01	6/12	10/8	2.91 ± 1.96 mon	600 pulse, 80% AMT, 1 sess/day, 2 weeks	contralesional CB	FMA-LE	/	Conventional rehabilitation therapies	/
Dysphagia
Xie et al.[43]	iTBS	12/6	66.90 ± 11.30	9/9	14/4	21.10 ± 20.11 d	600 pulses, 80% RMT, 1 sess/day, 2 weeks	Affected suprahyoid motor cortex	SSA, WST, MSS, PAS	2 weeks	Conventional swallowing therapy	/
Xie et al.[43]	sham	14/6	62.80 ± 13.00	8/12	13/7	23.70 ± 16.00 d	600 pulses, 80% RMT, 1 sess/day, 2 weeks	Affected suprahyoid motor cortex	SSA, WST, MSS, PAS	2 weeks	Conventional swallowing therapy	/
Rao et al.[44]	iTBS	22/11	63.42 ± 10.35	14/18	15/18	22.00 ± 8.00 d	600 pulses, 100% RMT, 1 sess/day, 2 weeks	Bilateral CB	FEDSS, PAS,SSA, FOIS	4 weeks	Conventional swallowing therapy	slight dizziness: 3
Rao et al.[44]	sham	24/7	65.90 ± 11.42	12/12	19/12	26.00 ± 3.00 d	600 pulses, 100% RMT, 1 sess/day, 2 weeks	Bilateral CB	FEDSS, PAS,SSA, FOIS	4 weeks	Conventional swallowing therapy	/

Abbreviations: AMT Active motor threshold, AH Affcted hemisphere, AQ Aphasia Quotient, ARAT Action Research Arm Test, BBS Berg Balance Scale, BBT Box and Block test, BCT Bird Cancellation Task, BIT Behavioral Inattention Test, BNT Boston Naming Test, CB Cerebellum, CBS Catherine Bergego Scale, CCAT Concise Chinese Aphasia Test, COWAT Controlled Oral Word Association Test, DLPFC Dorsolateral prefrontal cortex, FEDSS Fiberoptic Endoscopic Dysphagia Severity Scale, FMA Fugl-Meyer Assessment, FOIS Functional Oral Intake Scale, IFG Inferior frontal gyrus, iTBS intermittent theta burst stimulation, JTT Jebsen Taylor Test, LBT Line bisection test, LE Lower extremity, LH Left hemisphere, LOTCA Loewenstein Occupational Therapy Cognitive Assessment, MAS Modified Ashworth scale, M1 Primary motor cortex, MMSE Mini‐mental state examination, MSS Murray Secretion Scale, NHPT Nine-hole peg test, N/A Not available, OCS Oxford cognitive screen, PAS Penetration/Aspiration Scale, PPC Posterior parietal cortex, PPVT Peabody Picture Vocabulary Test, pSTG Posterior superior temporal gyrus, RH Right hemisphere, RBANS Repeatable Battery for the Assessment of Neuropsychological Status, RMT Resting motor threshold, SCT Star cancellation test, SFT Semantic Fluency Test, SSA Standardized Swallowing Assessment, UE Upper extremity, UH Unaffcted hemisphere, WAB-R Western Aphasia Battery-Revised, WMFT Wolf Motor Function Test, WST Water-swallowing test

Back to article page

ISSN: 1471-2377

Contact us

General enquiries: journalsubmissions@springernature.com

BMC Neurology

Contact us