• Fawaz Al-Hussain, Eman Nasim, Muhammad Iqbal, Nouf Altwaijri, Niaz Asim, Woo-Kyoung Yoo, and Shahid Bashir.
• Department of Neurology, Faculty of Medicine, King Saud University, Riyadh.
• Medicine (Baltimore). 2021 Feb 12; 100 (6): e24718e24718.

BackgroundMotor deficits are common after stroke and are a major contributor to stroke-related disability and the potential for long-lasting neurobiological consequences of stroke remains unresolved. There are only a few treatments available for the improvement of motor function in stroke patients. However, the mechanisms underlying stroke recovery remain poorly understood, and effective neurorehabilitation interventions remain insufficiently proven for widespread implementation.MethodsHerein, we propose to enhance the effects of brain plasticity using a powerful noninvasive technique for brain modulation consisting of navigated transcranial magnetic stimulation (TMS) priming with transcranial direct current stimulation (tDCS) in combination with motor-training-like constraint-induced movement therapy (CIMT). Our hypothesis is that navigated low-frequency rTMS stimulus priming with precise location provided by neuronavigation on the healthy side of the brain and with anodal tDCS on the affected side combined with CIMT will induce a greater motor function improvement than that obtained with sham tDCS combined with CIMT alone. We predict that the application of this technique will result in a large reduction in cortical excitability and dis-inhibition in the affected hemisphere and lead to improvements in behavioral measures of hand function in stroke patients.DiscussionThe proposed study, therefore, is important for several reasons. The results could potentially lead to improved stroke therapeutics, and the approach makes use of 2 potential pathways to modulate brain function.Trial RegistrationThis study protocol was registered in Clinical Trials Registry (https://clinicaltrials.gov/ct2/show/NCT04646577).Ethics And DisseminationThe study has been reviewed and approved by the Human Research Ethics Committee of the King Fahad Specialist Hospital Dammam. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, broadcast media, print media, the internet and various community/stakeholder engagement activities.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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