High-frequency versus theta burst transcranial magnetic stimulation for the treatment of poststroke cognitive impairment in humans

Objective Because the reliability of repetitive transcranial magnetic stimulation(rTMS)in treating poststroke cognitive impairment has not been convincingly demonstrated,we systematically examined the effectiveness of this regimen with 2 protocols.Methods We randomly allocated 41 patients with poststroke cognitive impairment to receive 5 Hz rTMS(n=11),intermittent theta burst stimulation(iTBS;n=15)or sham stimulation(n=15).Each group received 10 stimulation sessions over the left dorsolateral prefrontal cortex.We performed the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)and the Beck Depression Inventory at baseline and after the intervention.Results The 5 Hz rTMS group showed significantly greater improvement than the sham group in RBANS total score(P=0.006),attention(P=0.001)and delayed memory(P<0.001).The iTBS group showed significantly greater improvement than the sham group in RBANS total score(P=0.005)and delayed memory(P=0.007).The 5 Hz rTMS group exhibited a superior modulating effect in attention compared to the iTBS group(P=0.016).Patients without comorbid hypertension(P=0.008)were predisposed to favourable therapeutic outcomes.Conclusions Our results demonstrated that both 5 Hz rTMS and iTBS were effective for poststroke cognitive impairment in terms of global cognition,attention and memory function;the domain of attention was susceptible to 5 Hz modulation.Treatment with 5 Hz rTMS may slow cognitive decline,representing both a pivotal process in poststroke cognitive impairment and an aspect of neuroplasticity that contributes to disease-modifying strategies.