Motor Improvements Following Non-Invasive Brain Stimulation with kTMP: A Case Study of Cerebellar Stroke

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Chronic cerebellar ataxia following focal cerebellar hemorrhage (n=1). Intervention: Amplitude-modulated kilohertz transcranial magnetic perturbation (AM-kTMP) vs. Sham kTMP stimulation (E-field = 0 V/m) with identical behavioral protocol (verbal fluency and gait/balance exercises). Primary outcome: International Cooperative Ataxia Rating Scale (ICARS) and Berg Balance Scale (BBS) scores.

Amanda Chirino‐Pérez; Christina Merrick; Fredy Miranda-Casasola; Ludovica Labruna; Daniel Sheltraw; Richard B. Ivry

doi:10.1007/s12311-026-02078-z

September 11, 2026The CerebellumOpen Access

Motor Improvements Following Non-Invasive Brain Stimulation with kTMP: A Case Study of Cerebellar Stroke

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Key result

AM-kTMP improves ICARS ataxia score by ~8 points following cerebellar stroke.

n=1

Why the study?

Cerebellar ataxia causes debilitating impairments with no established effective treatments, motivating exploration of novel non-invasive brain stimulation methods.

Does cerebellar-targeted amplitude-modulated kilohertz transcranial magnetic perturbation (AM-kTMP) combined with behavioral training improve motor ataxia, balance, and cognitive function in a patient with chronic post-stroke cerebellar ataxia?

Key Points

To evaluate whether amplitude-modulated kilohertz transcranial magnetic perturbation (AM-kTMP) combined with behavioral training can improve motor stability and ataxia symptoms following a cerebellar hemorrhagic stroke.
Treated a 78-year-old patient 3 years post-hemorrhagic cerebellar stroke using AM-kTMP targeted to vermal, paravermal, and right Crus I/II cerebellar regions with an estimated maximum induced electric field of ~6 V/m.
Used a two-phase protocol: a 1-week unblinded open-label pilot (Phase 1), followed by an 8-week break and a fixed-sequence Phase 2 consisting of 1 week of sham stimulation followed by 1 week of active AM-kTMP.
Assessed clinical outcomes using the International Cooperative Ataxia Rating Scale (ICARS), Berg Balance Scale (BBS), and Cerebellar Cognitive Affective Syndrome (CCAS) scale, alongside objective kinematic measures of stride time variability and mediolateral postural sway.
Following Phase 1 active stimulation, the ICARS total score dropped to 30 (an 8-point improvement over baseline) isolated to posture and gait disturbance items, and BBS score reached 34 (a 6-point gain).
In Phase 2, sham stimulation produced minimal clinical changes, whereas active AM-kTMP restored the ICARS score to 30/100, raised the BBS score to 38/56 (a 10-point total gain over baseline), and reduced stride time variability and mediolateral postural sway.
CCAS total scores increased from 84 at baseline to 113/120 by study end (transitioning from 'Possible CCAS' to 'No CCAS'), while semantic fluency word retrieval rose to 26 words after Phase 1 and 23 after active Phase 2 compared to 17 at baseline.

Study Design

Type

Case Report (n=1)

Blinding

Open-label in Phase 1; double-blind in Phase 2

Multicenter

No

Structured PICO

Does cerebellar-targeted amplitude-modulated kilohertz transcranial magnetic perturbation (AM-kTMP) combined with behavioral training improve motor ataxia, balance, and cognitive function in a patient with chronic post-stroke cerebellar ataxia?

P

Population

1 female patient (age 78) with chronic cerebellar ataxia 3 years and 2 months post-hemorrhagic stroke, followed through an open-label week, an 8-week break, and a 3-week sham-active crossover phase.

I

Intervention

Amplitude-modulated kilohertz transcranial magnetic perturbation (AM-kTMP) using a 3.5 kHz carrier frequency amplitude-modulated at 3 Hz (inducing ~6 V/m E-field at superficial cerebellar cortex, coil positioned 2 cm below and 1 cm right of the inion) delivered in four 5-min blocks (20 min total/day) for 5 consecutive days in Phase 1 and 5 days in Phase 2, combined with concurrent verbal fluency tasks and inter-block gait/balance exercises.

C

Comparator

Sham stimulation (E-field = 0 V/m) delivered for 1 week in Phase 2 prior to active recirculation, combined with the identical behavioral protocol (fluency tasks during stimulation and gait/balance exercises between blocks) and background weekly physical therapy.

O

Outcome

Clinical ataxia and balance scales: International Cooperative Ataxia Rating Scale (ICARS) and Berg Balance Scale (BBS) assessed 3 days after each 5-day stimulation week.hard clinical

Limitations

Single-case study design
Absence of patient and experimenter blinding during Phase 1
Fixed sham-before-active sequence in Phase 2 limiting control for order effects
Limited to a non-progressive cerebellar stroke patient rather than degenerative cerebellar disorders
Lack of neurophysiological outcome measures to confirm cerebellar circuit engagement
Single-case design (n=1)
Absence of blinding during Phase 1
Tested only in non-progressive post-stroke ataxia rather than degenerative ataxia
Practice effects could not be excluded for cognitive (CCAS) improvements
Lack of neurophysiological outcome measures to confirm circuit engagement

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Implication

First clinical case demonstrating that cerebellar-targeted AM-kTMP is safe, imperceptible, and capable of producing clinically meaningful improvements in gait and balance in chronic post-hemorrhagic cerebellar ataxia.

Abstract

Cerebellar ataxia results in debilitating impairments in balance, gait, and cognition, with no established effective treatments. Kilohertz transcranial magnetic perturbation (kTMP) is a novel subthreshold non-invasive brain stimulation (NIBS) method that delivers strong, subthreshold electric fields to the cerebellar cortex without discomfort. We present the case of a 78-year-old patient with cerebellar ataxia following hemorrhagic stroke who underwent amplitude-modulated kTMP (AM-kTMP) targeted to vermal and paravermal cerebellar regions. The design involved an open-label phase followed by a fixed-sequence sham-active comparison. Active AM-kTMP, delivered as part of a NIBS-training protocol, produced improvements on clinical scales of ataxia alongside enhanced gait stability, with no device-related adverse reactions, representing a promising NIBS intervention for cerebellar disorders.

Discussion

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Cite This Study

Chirino‐Pérez et al. (2026) conducted a case report in Chronic cerebellar ataxia following focal cerebellar hemorrhage (n=1). Amplitude-modulated kilohertz transcranial magnetic perturbation (AM-kTMP) vs. Sham kTMP stimulation (E-field = 0 V/m) with identical behavioral protocol (verbal fluency and gait/balance exercises) was evaluated on International Cooperative Ataxia Rating Scale (ICARS) and Berg Balance Scale (BBS) scores. AM-kTMP improved ICARS ataxia score by 8 points (38 to 30) and Berg Balance Scale by 10 points (28 to 38) with reduced gait variability in a cerebellar stroke patient.

synapsesocial.com/papers/6aa7b3580926e14a848b2212 https://doi.org/10.1007/s12311-026-02078-z

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Motor Improvements Following Non-Invasive Brain Stimulation with kTMP: A Case Study of Cerebellar Stroke

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Motor Improvements Following Non-Invasive Brain Stimulation with kTMP: A Case Study of Cerebellar Stroke

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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