Brain Stimulation Paired With Rehabilitation for Arm Weakness After Stroke

Who can take part

• Within the first year to 3 years after the first stroke
• Unilateral infarction located in the territory of the middle cerebral artery, but not involving the cerebellum, thalamus, and brainstem
• Aged 18-80 years
• TMS standard: TMS induces muscle evoked potential (MEP). In the contracted state of the paralyzed muscle (maximum voluntary contraction of 20-50%), a reliable standard MEP (in 5/10 trials with 50-100uv) can be induced
• Researchers determine the medical and neurological condition of the participant to be stable based on the participant's medical history, physical examination, and neurological examination
• Moderate-severe unilateral upper limb paralysis, i.e., the Fugl-Meyer Assessment (FMA-UE) scale score is ≤47
• The distal extremity of the limb has some degree of motor function (flexion of the elbow joint or extension of the elbow joint or partial finger flexion with FMA-UE ≥1)
• mRS<4 points, able to cooperate with assessment and rehabilitation
• No spasticity or mild spasticity in any part of the affected limb (intramuscular rotator muscle and adductor muscle of the shoulder joint, flexor muscle of the elbow joint, flexor muscle of the wrist joint or finger flexor muscle), modified Ashworth scale (MAS) <4 points
• MMSE>24 points

Who cannot take part

• Unable to stop anticoagulation treatment at least 10 days prior to surgery (i.e., antiplatelet and/or anticoagulant therapy)
• Switching to oral spasticity medication within 2 weeks of enrollment, or injection of botulinum toxin in the affected arm within 4 months, and/or intention to start taking spasticity medication or inject botulinum toxin during the study follow-up period or within 12 months after implantation
• Participated in another device, biological, or drug study within 30 days of consenting to participate in the current study
• Received decompressive craniectomy
• Primary hemorrhagic stroke or severe hemorrhagic conversion
• Any progressive neurological or somatic disease that impairs the function of the affected limb other than stroke
• Any other neurological disorder that may compromise study safety, including central nervous system vasculitis, intracranial tumors, intracranial aneurysms, multiple sclerosis, or arteriovenous malformations
• Exclusion of cardioembolic stroke, patients requiring long-term anticoagulation
• Seizure(s) after stroke or potential risk of seizure(s)
• The presence of active psychosis that may affect treatment effect, such as psychosis or severe personality disorder
• Diagnosis of dementia
• Uncontrolled hypertension or history of cardiovascular disease for a long time
• The patient has severe cerebral small vessel disease, basilar artery vascular disease, and/or any other structural abnormalities of the cerebellum, cerebellar peduncles, and brainstem that prevent safe placement of DBS
• The investigator determines that the patient has a condition that would significantly increase the risk of study non-compliance, study safety, and/or study integrity. For the safety of the subject, for example, if the subject experiences an exacerbation of their condition, a serious adverse event, or poor compliance
• Moderate to severe neglect or disinhibition of the affected limb
• Pain intensity on the affected limb NRS ≥5 or severe sensory disturbance, NIHSS (item 8) = 2
• Untreated or inadequately treated depression, i.e., Beck Depression Inventory score of 20 or more at admission
• MRI contraindications, such as implanted metal devices or electronic devices (pacemakers, defibrillators, spinal cord stimulators)
• Non-pregnant or fertile women must use acceptable contraception, and pregnant women are excluded or terminated from the study