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

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.