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This study aims to assess the combined therapeutic effects of MEP-guided scalp acupuncture and repetitive transcranial magnetic stimulation on upper extremity motor function in stroke patients.

February 25, 2026Open Access

MEP-Guided Scalp Acupuncture Combined with Repetitive Transcranial Magnetic Stimulation for Post-Stroke Upper Extremity Motor Impairment: A Randomized Controlled Study Protocol

DKDebiao KongZhejiang Chinese Medical University XHXiaohan HuangNanjing University of Chinese Medicine SZShiyu ZhangZhejiang Chinese Medical University

Key Points

This study aims to assess the combined therapeutic effects of MEP-guided scalp acupuncture and repetitive transcranial magnetic stimulation on upper extremity motor function in stroke patients.
Prospective, single-blind, randomized controlled trial design
Participants with stroke-induced upper limb motor deficits
Random assignment to experimental group (combined therapy) or control group (rTMS alone)
4-week intervention with concurrent conventional rehabilitation
Follow-up assessments conducted 4 weeks post-treatment
Primary outcome measures include Fugl-Meyer Assessment-Upper Extremities and maximum MEP amplitude
Secondary outcomes include Action Research Arm Test, Modified Barthel Index, and fNIRS data
Expected to reveal synergistic effects of combined therapy on motor recovery

Abstract

Background: Post-stroke upper extremity motor impairment poses a significant challenge to rehabilitation. While repetitive transcranial magnetic stimulation (rTMS) and scalp acupuncture are effective individually, the precise mechanisms and synergistic efficacy of their combination remain to be fully elucidated. Purpose: This study aims to evaluate the therapeutic efficacy of MEP-guided scalp acupuncture combined with rTMS versus rTMS alone. Additionally, it intends to investigate the underlying neuromodulation mechanisms using functional near-infrared spectroscopy (fNIRS). Methods: This prospective, single-blind, randomized controlled trial includes patients with stroke-induced upper limb motor deficits. Participants are randomly assigned to either an experimental group (combined therapy) or a control group (rTMS alone) for a 4-week intervention. Both groups receive concurrent conventional rehabilitation. Follow-up assessments will be conducted 4 weeks after the completion of the treatment to evaluate the sustained effects. Results: Primary clinical outcome measures include the Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and maximum amplitude of Motor Evoked Potentials (MEP). Secondary clinical outcome measures include Action Research Arm Test (ARAT), Modified Barthel Index (MBI) and fNIRS data acquisition. Conclusion: This study is expected to provide evidence for an optimized, multi-target rehabilitation regimen. By integrating clinical scales with fNIRS neuroimaging, it seeks to reveal the neural mechanisms of brain network reorganization driven by this combined therapy. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT07210944. Keywords: scalp acupuncture, repetitive transcranial magnetic stimulation, upper extremity motor impairment, protocol

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