Brain-Oscillation-Synchronized Stimulation to Enhance Motor Recovery in Early Subacute Stroke

Prior treatment

• Intraocular metal, cochlear implants
• Participation in other studies if they are MDR or AMG studies or there is otherwise a high risk of insurance law issues intervening between two studies. In case of uncertainty, competing insurances must be contacted prior to participation

Other illness

• Hemorrhagic stroke (this refers to primary intracerebral hemorrhage only; hemorrhagic transformation of ischemic infarcts is not an exclusion criterion)
• If TMS might interact with sensors of active implants (e.g., intra-cardiac defibrillators).
• History of seizures or epilepsy.
• Treatment intervention can't be started within 14 days after onset of stroke.
• persistent addiction disorder (except for nicotine dependence)

Other

• Subjects presenting with any of the following criteria will not be included in the trial:
• Estimated life expectancy \< 12 months
• Presence of intracranial ferromagnetic metal (extracranial stents ≥10 cm away from the TMS coil are acceptable) in accordance with current safety guidelines \[18\]
• If a cranial bone gap affects currents induced by TMS (such as after craniotomy).
• Women during pregnancy and lactation.
• CNS malignoma
• If there is any concern by the investigator regarding the safe participation of the subject in the study or for any other reason the investigator considers the subject inappropriate for participation in the study.
• The ability to consent for patients who are unable to speak will be assessed on the basis of the NIHS-Score by an independent physician (details see chapter 21 and appendix).

• Subjects meeting all of the following criteria will be considered for admission to the trial:
• Age ≥ 18 years at the time of signing the informed consent.
• Cerebral ischemia identified by brain imaging (cerebral MRI or CT) occurred 1-14 days ago.
• Subject understands and voluntarily signs an informed consent document prior to any study related assessments/procedures.
• Stroke has resulted in a new arm-/hand motor deficit with ≤ 50 points in the FMA-UE.
• Presence of motor evoked potentials (MEPs) in the paretic hand. MEPs has to be obtained in the resting muscle
  • o If no MEPs can be obtained, MEP search procedure can be repeated later up to 14 days after stroke onset.
• ● μ-oscillation (8-12 Hz) is recordable by EEG in the ipsilesional sensorimotor cortex with a sufficient signal-to-noise ratio of at least 3 dB
• ● Subject is able to adhere to the study visit schedule and other protocol requirements.