Pilot randomized trial of high- and low-frequency repetitive transcranial magnetic stimulation in post-stroke depression with EEG monitoring

Front Neurol. 2025 Oct 15;16:1671487. doi: 10.3389/fneur.2025.1671487. eCollection 2025.

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.

PMID:41170333 | PMC:PMC12570175 | DOI:10.3389/fneur.2025.1671487