Pilot randomized trial of high- and low-frequency repetitive transcranial magnetic stimulation in post-stroke depression with EEG monitoring
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Date
2025
Authors
Su, X.
Zhu, L.
Shi, X.
Pei, Z.
Hordacre, B.
Yan, N.
Guo, Y.
Dang, G.
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Journal article
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Frontiers in Neurology, 2025; 16(1671487):1-
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Abstract
Background: Post-stroke depression (PSD) is a prevalent complication that adversely affects recovery following stroke. Repetitive transcranial magnetic stimulation (rTMS) has garnered attention as a potential therapeutic intervention for PSD. This pilot double-blind randomized trial aimed to assess the feasibility and preliminary effects of high- and low-frequency rTMS in PSD, while exploring potential neural mechanisms using electroencephalography.
Methods: Chronic stroke survivors diagnosed with PSD were randomly allocated to receive either high-frequency rTMS targeting the left dorsolateral prefrontal cortex or low-frequency rTMS targeting the right dorsolateral prefrontal cortex for 20 sessions. Hamilton Depression Rating Scale were assessed, and resting-state electroencephalography were recorded at baseline, mid-treatment, and post-treatment.
Results: Both high- and low-frequency rTMS were well tolerated and reduced depressive symptoms at mid- and post-treatment. Electroencephalography analysis did not reveal divergent neural signatures associated with the two protocols. However, altered connectivity linking posterior divisions of the middle frontal gyrus and specific regions in the theta- and beta-band frequencies were associated with the improvement in Hamilton Depression Rating Scale scores.
Conclusion: This pilot study provides preliminary evidence that rTMS is feasible for managing PSD across both high- and low-frequency protocols. EEG analyses suggest potential neurobiological mechanisms, which may inform future research on treatment optimization.
Clinical trial registration: chictr.org.cn, ChiCTR1900021168.
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Copyright 2025 u, Zhu, Shi, Pei, Hordacre, Yan, Guo and Dang. (http://creativecommons.org/licenses/by/4.0/)
Access Condition Notes: This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.