Evidence map›Paper›PMID 40209285›Full record

ArticleJournal of the neurological sciences2025

Stratification algorithm for repetitive TMS in stroke (START): Results from an exploratory crossover study.

Yin-Liang Lin, Kelsey A Potter-Baker, Vishwanath Sankarasubramanian, David A Cunningham, Manshi Li, Kyle O'Laughlin, Adriana B Conforto, Xiaofeng Wang, Ken Sakaie, Jayme Knutson and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the neurological sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Yin-Liang LinDepartment of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Kelsey A Potter-BakerDepartment of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veteran's Affairs, Cleveland, OH, USA; Department of Health and Biomedical Sciences, University of Texas Rio Grande Valley, Edinburg, TX, USA.
Vishwanath SankarasubramanianDepartment of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
David A CunninghamDepartment of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio, USA; Cleveland Functional Electrical Stimulation Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.
Manshi LiDepartment of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Kyle O'LaughlinDepartment of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Adriana B ConfortoHospital Israelita Albert Einstein and LIM-44/Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Xiaofeng WangDepartment of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Ken SakaieDepartment of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
Jayme KnutsonDepartment of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio, USA; Cleveland Functional Electrical Stimulation Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.
Andre G MachadoNeurological Institute, Cleveland Clinic, OH, USA.
Ela B PlowDepartment of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Rehabilitation Hospitals (CCRH), Cleveland, OH, USA. Electronic address: plowe2@ccf.org.

Funding

Contralaterally Controlled FES Combined with Brain Stimulation for Severe Upper limb HemiplegiaR01HD098073 · NICHD · CLEVELAND CLINIC LERNER COM-CWRU · PI PLOW, ELA B · 2019 to 2024
$3.1M
Brain Stimulation- aided Stroke Rehabilitation: Neural Mechanisms of RecoveryK01HD069504 · NICHD · CLEVELAND CLINIC LERNER COM-CWRU · PI PLOW, ELA B · 2011 to 2015
$531k
American Heart Association-American Stroke Association AHA_13BGIA17120055NICHD NIH HHS K01 HD069504NICHD NIH HHS R01 HD098073
6 · The paper itself

Abstract

The role of contralesional motor cortices in paretic upper extremity (UE) motor recovery following stroke varies based on available structural reserve. However, an optimal measure of the reserve to stratify patients for different contralesional brain stimulation remains unknown. This study aimed to establish severity criteria distinguishing which patients benefit more from inhibitory contralesional motor cortex (M1) stimulation versus facilitatory contralesional dorsal premotor cortex (cPMd) stimulation. Twenty-four chronic stroke participants underwent three repetitive transcranial magnetic stimulation (rTMS) sessions: inhibitory 1 Hz rTMS to contralesional M1, facilitatory 5 Hz rTMS to cPMd, and sham rTMS. Motor performance on a reaching task (RT) was assessed pre- and post-stimulation. Baseline assessments included UE Fugl-Meyer (UEFM), corticospinal integrity (fractional anisotropy), and motor evoked potentials (MEPs). Classification and Regression Tree (CART) analysis identified UEFM 42 as the threshold distinguishing patients who improved with cM1 inhibition versus cPMd facilitation rTMS, with 91.6 % and 83.3 % accuracy, respectively. Participants with UEFM>42 showed greater RT gains with inhibitory rTMS than more severely impaired individuals (p = 0.06), whereas those with UEFM≤42 demonstrated greater RT gains with facilitatory cPMd rTMS than sham (p = 0.003). Less-severe participants had larger increases in ipsilesional MEPs following inhibitory rTMS (p = 0.007), whereas more-severe (UEFM≤42) MEP-absent participants had larger reductions in interhemispheric inhibition (IHI) following facilitatory cPMd rTMS (p = 0.028). Our findings support the bimodal theory and introduce the START (Stratification Algorithm for rTMS) framework, utilizing clinical impairment and white matter integrity to stratify response. While promising, the START algorithm requires further validation in larger samples to develop targeted and effective neuromodulation treatments.

Indexed as

AlgorithmsMotor CortexStrokeTranscranial Magnetic StimulationAdultAgedCross-Over StudiesEvoked Potentials, MotorFemaleFunctional LateralityHumansMaleMiddle AgedStroke RehabilitationBrain stimulationInterhemispheric inhibition (IHI)NeuromodulationRepetitive transcranial magnetic stimulation (rTMS)Stroke

Identifiers

PMID40209285
PMCPMC13633852

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.