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Effect of intermittent theta burst stimulation on attention deficits after stroke: a randomized controlled clinical trial
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DOI：10.1186/s40001-026-05009-0.png)
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Abstract
En 中文
Previous studies have demonstrated that high-frequency repetitive transcranial magnetic stimulation (rTMS) applied to the left dorsolateral prefrontal cortex (DLPFC) could improve post-stroke attention deficit (PSAD). The clinical effectiveness of intermittent theta burst stimulation (iTBS), a more time-efficient excitatory stimulation protocol, remains unclear. This study aims to evaluate the clinical efficacy of iTBS on PSAD and to explore its associated neurophysiological correlates. In this randomized controlled clinical trial, 40 patients with PSAD received either real or sham iTBS targeting the left DLPFC for 2 weeks. Global cognitive function and attention were assessed using the Montreal Cognitive Assessment (MoCA) and digit span test (DST). Specific attention components were evaluated, including sustained attention (letter cancellation test, LCT), selective attention (Stroop Color–Word Test C, ST-C), divided attention (paced auditory serial addition test, PASAT), and shifting attention (Trail Making Test-B, TMT-B). Event-related potential P300 was assessed at baseline (T0), post-intervention (T1), and at 4-week follow-up (T2). In addition, proton magnetic resonance spectroscopy (1H-MRS) was performed in 16 patients at baseline and post-intervention. Compared with the sham group, the iTBS group showed greater improvements after treatment in MoCA, DST forward, DST backward, TMT-B, LCT, PASAT, and P300 amplitude, with moderate-to-large effect sizes for significant outcomes. Representative effects were observed for MoCA (mean difference = 3.25, 95% CI 1.34 to 5.16, Hedges’ g = 1.08, P = 0.001), PASAT (mean difference = 3.75, 95% CI 2.23 to 5.27, Hedges’ g = 1.55, P < 0.001), and P300 amplitude (mean difference = 1.66 μV, 95% CI 0.29 to 3.03, Hedges’ g = 0.76, P = 0.019). At the 2-week follow-up after treatment, greater improvements were observed in MoCA, DST backward, TMT-B, LCT, PASAT, P300 latency, and P300 amplitude. In the 1H-MRS subgroup, the iTBS group showed a greater increase in the NAA/Cr ratio than the sham group. Changes in P300 latency were associated with changes in LCT and PASAT scores, and changes in the NAA/Cr ratio were associated with changes in TMT-B duration. Two-week iTBS targeting the left DLPFC may improve attention performance in patients with PSAD, particularly sustained, divided, and shifting attention, with benefits lasting for at least 2 weeks after treatment. These improvements were associated with changes in P300 and 1H-MRS metabolic indicators, suggesting potential neurophysiological and metabolic correlates of treatment response. Trial registration Chinese Clinical Trial Registry (www.chictr.org.cn), Identifier: ChiCTR2300068669. Registered on 27 February 2023.
Keywords:
Stroke
Attention deficit
Intermittent theta burst stimulation (iTBS)
Dorsolateral prefrontal cortex (DLPFC)
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