BOSS-STROKE

Hirnzustandsabhängige, transkranielle Magnetstimulation zur motorischen Rehabilitation der oberen Extremität in frühen Schlaganfallstadien

01.05.2022 bis 31.10.2025

Globally, stroke is the third most frequent cause of death and the most frequent cause of permanent
disability. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and relatively painless form
of therapeutic brain stimulation. It showed moderate effect size in improving paretic arm-/hand function in
stroke patients, indicating a strong medical need for better interventions.
BOSS-STROKE is a multicenter randomized controlled double-blind three-arm parallel-group exploratory
trial comparing novel personalized, conventional non-personalized and sham rTMS on arm-/hand function
in subacute stroke patients. Personalized rTMS is a highly innovative form of stimulation that synchronizes
rTMS to specific brain states identified by real-time analysis of electroencephalography (EEG). The TMS
pulses are applied at the optimal instants in time to maximize the desired neuromodulatory effect: a longterm
increase in the activity of the motor networks affected by the stroke lesion. In preparatory studies, we
have repeatedly demonstrated that personalized rTMS synchronized to the negative peak of the ongoing
sensorimotor μ-oscillation induced more reliable and larger neuromodulatory effects than standard nonpersonalized
rTMS. The question we address for the first time here is to what extent this novel treatment
translates into a meaningful clinical benefit, i.e., improved paretic hand-/arm function in stroke. We expect
that this approach can relevantly improve the quality of life of many stroke patients in Germany.