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Background <p>Spasticity is one of the most disabling stroke consequences, post-stroke spasticity (PSS). By acting via preventing acetylcholine release at the neuromuscular junction, intra-muscular injection of botulinum toxin A (BoNT-A) can reduce PSS. In addition, noninvasive brain stimulation (NIBS) specifically repetitive transcranial magnetic stimulation (rTMS), is well-defined to impact neuro-plastic changes and control the healing of injured brain areas.</p> Objectives <p>The current study aimed to evaluate the combined effect of ultrasonography (US)-guided local BoNT-A injection (for better accuracy and safety) and ipsilesional high-frequency rTMS (HF-rTMS) on spastic UL in chronic post-stroke patients.</p> Patients and methods <p>80 patients with post-stroke spastic upper limb (UL) were under US guidance injected with BoNT-A, then randomly allocated to treatment with 20&#xa0;Hz rTMS (HF-rTMS group, group 1), <i>N</i> = 40 or SHAM group (group 2), <i>N</i> = 40, applied over the ipsilesional cortex over 4&#xa0;weeks. The motor function of the affected UL was evaluated serially by Wolf motor function tests (WMFT) just before BoNT-A administration, 1.5&#xa0;months and 3&#xa0;months after administration.</p> Results <p>The high-frequency rTMS group showed significant improvement of spastic muscles function as evident by WMFT.</p> Conclusions <p>These findings suggested that, the application of HF-rTMS over the ipsilesional cerebral cortex following local US-guided BoNT-A injection contributes in improving motor function of upper limb in chronic post-stroke patients.</p>

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Functional outcome of repetitive transcranial magnetic stimulation in spastic paretic upper limb after ultrasonography-guided botulinum toxin injection in patients with stroke

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月14日

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  • Rehab G. Taha,
  • Mohamed M. Abdelkader,
  • AbdEl-Raoof O. Abd El-Baky,
  • Enas M. Hassan,
  • Wael T. Soliman

摘要

Background

Spasticity is one of the most disabling stroke consequences, post-stroke spasticity (PSS). By acting via preventing acetylcholine release at the neuromuscular junction, intra-muscular injection of botulinum toxin A (BoNT-A) can reduce PSS. In addition, noninvasive brain stimulation (NIBS) specifically repetitive transcranial magnetic stimulation (rTMS), is well-defined to impact neuro-plastic changes and control the healing of injured brain areas.

Objectives

The current study aimed to evaluate the combined effect of ultrasonography (US)-guided local BoNT-A injection (for better accuracy and safety) and ipsilesional high-frequency rTMS (HF-rTMS) on spastic UL in chronic post-stroke patients.

Patients and methods

80 patients with post-stroke spastic upper limb (UL) were under US guidance injected with BoNT-A, then randomly allocated to treatment with 20 Hz rTMS (HF-rTMS group, group 1), N = 40 or SHAM group (group 2), N = 40, applied over the ipsilesional cortex over 4 weeks. The motor function of the affected UL was evaluated serially by Wolf motor function tests (WMFT) just before BoNT-A administration, 1.5 months and 3 months after administration.

Results

The high-frequency rTMS group showed significant improvement of spastic muscles function as evident by WMFT.

Conclusions

These findings suggested that, the application of HF-rTMS over the ipsilesional cerebral cortex following local US-guided BoNT-A injection contributes in improving motor function of upper limb in chronic post-stroke patients.