Intermittent and continuous theta burst stimulation (iTBS/cTBS), a form of repetitive transcranial stimulation (rTMS), is often used to facilitate the affected hemisphere and inhibit the unaffected hemisphere, respectively. This study aims to examine the efficacy of combined iTBS and cTBS on motor outcomes of upper extremity (UE) in patients with stroke.

This was a double-blind randomized controlled trial enrolled patients from a rehabilitation department. Fourteen patients with first-ever chronic and unilateral cerebral stroke, aged 30–70 years, were randomly assigned to the combined TBS or sham group. All patients received 15 daily sessions of either TBS (combined iTBS over affected hemisphere and cTBS over the affected hemisphere) or sham stimulation in addition to conventional neurorehabilitation. Outcome measures, including Modified Ashworth Scale (MAS), Fugle–Meyer Assessment Upper Extremity (FMA-UE), Box and Block test (BBT), and Functional Independence Measure (FIM), were implemented before and immediately after the intervention. The change score is calculated as (post-treatment score - pre-treatment score). An independent t-test was used to compare the pre-treatment and change scores. A P<0.05 is considered as significant differences.

The TBS group showed greater improvement in the FMA than the sham group (P<0.05). However, the change scores in the MAS, BBT, and FIM did not achieve the significant differences between two groups.

The combined iTBS and cTBS may induce greater gains in functional improvement of upper limb. The combined iTBS and cTBS may emerge as an adjuvant intervention in neurorehabilitation. However, we could not draw the definite the conclusion due to limited case numbers. Future studies may increase the sample size and longitudinal follow-up.