After a stroke, the contralesional cerebellum is implicated in functional reorganization of the motor network. In animal models, stimulation of the cerebellar-cortical networks has been found to improve recovery. This study assessed the effect of cerebellar intermittent Omega-burst stimulation (CRB-iTBS), a variation of repetitive transcranial magnetic stimulation (rTMS), on gait recovery after a stroke.
METHODSSubjects were adult patients with chronic (over six months), first ever middle cerebral artery ischemic stroke with residual gait and balance impairment. Assessments included the Berg Balance Scale (BBS), the Fugl-Meyer (FM) assessment, the Barthel Index (BI) and gait analysis. A combination of TMS and electroencephalogram was used to determine the patterns of cortical reorganization. The patients were randomized to receive either active or sham CRB-iTBS.
All participants underwent three weeks of daily sham or active CRBiTBS, coupled with physical therapy. The CRB-iTBS was applied over the contralalesional cerebellum. During locomotion analysis, the patients were asked to walk at a comfortable speed. The primary efficacy analysis was the change from baseline in BBS scores, with secondary endpoints including changes in the FM and BI.
RESULTSAt three weeks, patients in the active group demonstrated greater improvement on the BBS (P＝ 0.03). The treatment group demonstrated significant improvements from baseline by 15.8% at T1 and 23.1% at T2. No significant change was noted in the control group. The gait analysis demonstrated that step width was significantly reduced in the treatment group.
CONCLUSIONThis study demonstrates that cerebellar intermittent omega burst stimulation in patients with chronic stroke can improve gait and balance.