FROM BRAIN STIMULATION TO FUNCTIONAL RESTORATION: EVALUATING RTMS AND TDCS IN POST-STROKE MOTOR RECOVERY TRAJECTORIES juliopaza98@gmail.com

PW05-08

FROM BRAIN STIMULATION TO FUNCTIONAL RESTORATION: EVALUATING RTMS AND TDCS IN POST-STROKE MOTOR RECOVERY TRAJECTORIES

6

India

Oral or Poster

Stroke remains a major global cause of long-term disability which significantly impact motor function and quality of life. Non-invasive brain stimulation techniques like repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have shown promise in promoting post-stroke neuroplasticity and enhancing motor recovery outcomes. However, clinical adoption is limited by variability in stimulation protocols, inconsistent outcomes, and insufficient data on long-term safety and efficacy.Thus, our study aimed to evaluates their real-world efficacy, safety, and optimal use timing.

We retrospectively analyzed 312 adult patients with ischemic or hemorrhagic stroke (1–6 months post-event) who underwent non-invasive brain stimulation at 11 neurorehabilitation centers.Patients were categorized into two groups based on intervention: rTMS (n=162) or tDCS (n=150). Data were obtained from institutional records and secondary databases (PubMed, ClinicalTrials.gov) between 2020–2024. Motor outcomes were assessed using the Fugl-Meyer Assessment (FMA) for upper limb recovery and Modified Rankin Scale (mRS) for functional status scores at baseline and 8 weeks. Adverse events and compliance were recorded. Statistical analyses included ANCOVA for adjusted group comparison and Kaplan-Meier for recovery sustainability. ROBINS-I was used for bias evaluation and data heterogeneity was evaluated using I² statistics.

Among 312 patients, those receiving rTMS demonstrated significantly greater motor recovery compared to the tDCS group, with mean FMA score improvements of +17.6±4.3 vs. +11.2±3.9 (p=0.01; 95% CI: 2.1–10.1). A favorable shift in mRS scores (≥1-point improvement) was observed in 61.1% of rTMS patients versus 48.0% in the tDCS group (χ²=6.27, p=0.012). Early intervention (<3 months post-stroke) correlated with higher functional gains across both groups (p<0.05). Kaplan-Meier analysis showed more sustained motor improvement in the rTMS group at 12-week follow-up (Log-rank p=0.037). Adverse effects were mild, with headache (8%), scalp irritation (5%), and no serious events reported. Protocol adherence exceeded 94.3%. Bias was rated low to moderate using ROBINS-I, and heterogeneity across centers was low (I²=12.4%).

Our finding demonstrates that rTMS offers superior motor recovery compared to tDCS in poststroke rehabilitation. Both modalities exhibit favorable safety profiles and high treatment adherence. These findings support the integration of non-invasive brain stimulation into standardized stroke rehabilitation protocols.