Cerebellar TMS May Improve Gait, Balance in Post-Stroke Hemiparesis


“Very exciting” results with magnetic stimulation in small trial.

Transcranial magnetic stimulation of the cerebellum led to improved post-stroke motor functions in a phase IIa randomized, double-blind sham-controlled trial in Italy, researchers said.

After 3 weeks of repetitive, intermittent theta-burst magnetic stimulation to the cerebellum (CRB-iTBS) and physical therapy, hemiparetic patients following ischemic stroke improved their ability to walk and keep their balance more than patients who received sham stimulation and physical therapy, reported Giacomo Koch, MD, PhD, of the Santa Lucia Foundation in Rome, and colleagues in JAMA Neurology.

“For the first time, we modulated the neural activity of the cerebellum in the context of a clinical trial in patients suffering from large stroke in the territory of the middle cerebral artery,” Koch told MedPage Today. “We found that cerebellar stimulation was able to improve the outcome when coupled with rehabilitation by changing the activity of neural networks connecting the cerebellum with the parietal cortex.”

Studies using non-invasive brain stimulation methods for post-stroke rehabilitation have had mixed results to date, Koch said. “But these studies mainly tried to modulate the activity of the primary motor cortex,” he pointed out. “Our study shows that targeting alternative networks connected with motor cortex may be a more successful strategy.”

The novelty here is targeting the cerebellum, noted Pablo Celnik, MD, of the Johns Hopkins University School of Medicine in Baltimore, who was not involved in the study.

“These results are very exciting because they suggest that stimulation of the cerebellum can be paired with physical therapy to augment the effects of rehabilitation,” Celnik told MedPage Today. “This is especially so for chronic stroke patients, whose condition is more difficult to improve.”

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