Microstate dynamics in motor imagery of stroke patients with transcranial alternating current stimulation modulation_Journal of Biomedical Engineering

Authors：

SONG Lei ^1,2 , ZHANG Ying ^3,4 , WEI Yujia ^2,5 , LIU Yuqing ^2,5 ,  WANG Chunfang ^3,4 ,  XU Guizhi ^1,2,5

1. School of Life Sciences and Health Engineering, Hebei University of Technology, Tianjin 300130, P. R. China;
2. State Key Laboratory of Intelligent Power Distribution Equipment and System, Hebei University of Technology, Tianjin 300130, P. R. China;
3. Department of Rehabilitation, The First Affiliated Hospital of Nankai University, Tianjin Union Medical Center, Tianjin 300121, P. R. China;
4. Tianjin Rehabilitation Institute, Tianjin 300121, P. R. China;
5. School of Electrical Engineering, Hebei University of Technology, Tianjin 300130, P. R. China;

Corresponding?author：

WANG Chunfang, Email: wangchunfang@umc.net.cn; XU Guizhi, Email: gzxu@hebut.edu.cn

Keywords：

Transcranial alternating current stimulation; Stroke; Motor imagery; Microstate

DOI：

10.7507/1001-5515.202508021

Video：

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Transcranial alternating current stimulation (tACS) holds significant potential for improving motor function in stroke patients, but its underlying mechanisms remain unclear. In this study, 20 Hz tACS was applied to 15 stroke patients, and their motor imagery (MI) signals were collected before and after stimulation, which were for assessment by combining with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Additionally, 11 subjects were recruited as a healthy control group. The study demonstrated that FMA-UE scores of stroke patients significantly increased after tACS intervention. The duration of EEG microstate C and F decreased significantly, while microstate D (coverage, duration, and occurrence probability) increased markedly, and microstate E decreased. The transition probabilities of C→D and D→B were positively correlated with FMA-UE scores. Based on these findings, this study concludes that 20 Hz tACS can enhance neuroplasticity and motor function in patients, and the transition probabilities (C→D/D→B) may serve as potential indicators for assessing motor function, providing experimental evidence for the clinical application of tACS and the development of rehabilitation brain-computer interfaces.

Citation： SONG Lei, ZHANG Ying, WEI Yujia, LIU Yuqing, WANG Chunfang, XU Guizhi. Microstate dynamics in motor imagery of stroke patients with transcranial alternating current stimulation modulation. Journal of Biomedical Engineering, 2026, 43(1): 26-33, 44. doi: 10.7507/1001-5515.202508021 Copy

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2.	Storch S, Samantzis M, Balbi M. Driving oscillatory dynamics: neuromodulation for recovery after stroke. Front Syst Neurosci, 2021, 15: 712664..
3.	Harada T, Hara M, Matsushita K, et al. Off-line effects of alpha-frequency transcranial alternating current stimulation on a visuomotor learning task. Brain Behav, 2020, 10(9): e01754..
4.	Yuan K, Chen C, Lou W T, et al. Differential effects of 10 and 20 Hz brain stimulation in chronic stroke: a tACS-fMRI study. IEEE Trans Neural Syst Rehabil Eng, 2022, 30: 455-464..
5.	Hamano Y H, Sugawara S K, Fukunaga M, et al. The integrative role of the M1 in motor sequence learning. Neurosci Lett, 2021, 760: 136081..
6.	Veldema J, Gharabaghi A. Non-invasive brain stimulation for improving gait, balance, and lower limbs motor function in stroke. J Neuroeng Rehabil, 2022, 19(1): 84..
7.	Elyamany O, Leicht G, Herrmann C S, et al. Transcranial alternating current stimulation (tACS): from basic mechanisms towards first applications in psychiatry. Eur Arch Psychiatry Clin Neurosci, 2021, 271(1): 135-156..
8.	Antal A, Paulus W. Transcranial alternating current stimulation (tACS). Front Hum Neurosci, 2013, 7: 317..
9.	張學軍, 李菲. 經顱交流電刺激對運動技能學習與鞏固的作用. 科學技術與工程, 2022, 22(27): 11850-11857..
10.	Di Rienzo F, Debarnot U, Daligault S, et al. Online and offline performance gains following motor imagery practice: a comprehensive review of behavioral and neuroimaging studies. Front Hum Neurosci, 2016, 10: 315..
11.	王建華, 陳蘇英, 王飛, 等. 運動想象的神經機制及其在偏癱康復應用中的研究進展. 中華物理醫學與康復雜志, 2021, 43(2): 184-186..
12.	Diaz Hernandez L, Rieger K, Baenninger A, et al. Towards using microstate-neurofeedback for the treatment of psychotic symptoms in schizophrenia. A feasibility study in healthy participants. Brain Topography, 2016, 29(2): 308-321..
13.	Damborská A, Piguet C, Aubry J M, et al. Altered Electroencephalographic resting-state large-scale brain network dynamics in euthymic bipolar disorder patients. Front Psychiatry, 2019, 10: 826..
14.	Yan Y, Gao M, Geng Z, et al. Abnormal EEG microstates in Alzheimer's disease: predictors of β-amyloid deposition degree and disease classification. Geroscience, 2024, 46(5): 4779-4792..
15.	Guo Y, Zhao X, Liu X, et al. Electroencephalography microstates as novel functional biomarkers for insomnia disorder. Gen Psychiatr, 2023, 36(6): e101171..
16.	Khanna A, Pascual-Leone A, Michel C M, et al. Microstates in resting-state EEG: current status and future directions. Neurosci Biobehav Rev, 2015, 49: 105-113..
17.	辛榕, 余賢嫻, 程斯曼, 等. 基于腦電微狀態和表面肌電觀察重復經顱磁刺激對腦卒中后右側偏癱患者上肢運動功能的影響. 中華物理醫學與康復雜志, 2024, 46(9): 791-798..
18.	王海力, 尹寧, 徐桂芝. 腦電圖微狀態分析及應用研究進展. 生物醫學工程學雜志, 2023, 40(1): 163-170..
19.	Xiong X, Ji X, Yi S, et al. Motor imagery EEG microstates are influenced by alpha power. Comput Methods Biomech Biomed Engin, 2025: 1-16..
20.	Milz P, Faber P L, Lehmann D, et al. The functional significance of EEG microstates-Associations with modalities of thinking. Neuroimage, 2016, 125: 643-656..
21.	Bréchet L, Brunet D, Birot G, et al. Capturing the spatiotemporal dynamics of self-generated, task-initiated thoughts with EEG and fMRI. Neuroimage, 2019, 194: 82-92..
22.	Antonova E, Holding M, Suen H C, et al. EEG microstates: Functional significance and short-term test-retest reliability. Neuroimage Rep, 2022, 2(2): 100089..
23.	Jabès A, Klencklen G, Ruggeri P, et al. Resting-state EEG microstates parallel age-related differences in allocentric spatial working memory performance. Brain Topogr, 2021, 34(4): 442-460..
24.	Seitzman B A, Abell M, Bartley S C, et al. Cognitive manipulation of brain electric microstates. Neuroimage, 2017, 146: 533-543..
25.	Du M, Peng Y, Li Y, et al. Effect of trait anxiety on cognitive flexibility: evidence from event-related potentials and resting-state EEG. Biol Psychol, 2022, 170: 108319..
26.	Chen X, Chen N X, Shen Y Q, et al. The subsystem mechanism of default mode network underlying rumination: A reproducible neuroimaging study. Neuroimage, 2020, 221: 117185..
27.	Vellante F, Ferri F, Baroni G, et al. Euthymic bipolar disorder patients and EEG microstates: a neural signature of their abnormal self experience?. J Affect Disord, 2020, 272: 326-334..
28.	D'Croz-Baron D F, Bréchet L, Baker M, et al. Auditory and visual tasks influence the temporal dynamics of EEG microstates during post-encoding rest. Brain Topogr, 2021, 34(1): 19-28..
29.	Kim K, Duc N T, Choi M, et al. EEG microstate features according to performance on a mental arithmetic task. Sci Rep, 2021, 11(1): 343..
30.	Wang L, Ding X, Zhang W, et al. Differences in EEG microstate induced by gaming: a comparison between the gaming disorder individual, recreational game users and healthy controls. IEEE Access, 2021, 9: 32549-32558..
31.	Murphy M, Stickgold R, Parr M E, et al. Recurrence of task-related electroencephalographic activity during post-training quiet rest and sleep. Sci Rep, 2018, 8(1): 5398..
32.	Xue S, Shen X, Zhang D, et al. Unveiling frequency-specific microstate correlates of anxiety and depression symptoms. Brain Topogr, 2025, 38(1): 12..
33.	Shi W, Li Y, Liu Z, et al. Non-canonical microstate becomes salient in high density EEG during propofol-induced altered states of consciousness. Int J Neural Syst. 2020, 30(2): 2050005..
34.	Tomescu M I, Papasteri C C, Sofonea A, et al. Spontaneous thought and microstate activity modulation by social imitation. Neuroimage, 2022, 249: 118878..
35.	Poskanzer C, Denis D, Herrick A, et al. Using EEG microstates to examine post-encoding quiet rest and subsequent word-pair memory. Neurobiol Learn Mem, 2021, 181: 107424..
36.	楊曉明, 劉陽, 王建華, 等. 慢性高原病患者默認網絡改變: 基于后扣帶回的功能連接研究. 磁共振成像, 2016, 7(2): 107-112..
37.	Ke M, Li J, Wang L. Alteration in resting-state EEG microstates following 24 hours of total sleep deprivation in healthy young male subjects. Front Hum Neurosci, 2021, 15: 636252..
38.	Tarailis P, ?imkut? D, Koenig T, et al. Relationship between spatiotemporal dynamics of the brain at rest and self-reported spontaneous thoughts: an EEG microstate approach. J Pers Med, 2021, 11(11): 1216..
39.	Baldini S, Sartori A, Rossi L, et al. Fatigue in multiple sclerosis: a resting-state EEG microstate study. Brain Topogr. 2024, 37(6): 1203-1216..
40.	Li D, Liu R, Ye F, et al. Modulation of brain function and antidepressant effects by transcranial alternating current stimulation in patients with major depressive disorder: Evidence from ERP. J Psychiatr Res. 2024, 176: 1-8..
41.	San-Juan D, Espinoza-López D A, Vázquez-Gregorio R, et al. A pilot randomized controlled clinical trial of transcranial alternating current stimulation in patients with multifocal pharmaco-resistant epilepsy. Epilepsy Behav. 2022, 130: 108676..

1. Stinear C M, Lang C E, Zeiler S, et al. Advances and challenges instroke rehabilitation. Lancet Neurol, 2020, 19(4): 348-360..
2. Storch S, Samantzis M, Balbi M. Driving oscillatory dynamics: neuromodulation for recovery after stroke. Front Syst Neurosci, 2021, 15: 712664..
3. Harada T, Hara M, Matsushita K, et al. Off-line effects of alpha-frequency transcranial alternating current stimulation on a visuomotor learning task. Brain Behav, 2020, 10(9): e01754..
4. Yuan K, Chen C, Lou W T, et al. Differential effects of 10 and 20 Hz brain stimulation in chronic stroke: a tACS-fMRI study. IEEE Trans Neural Syst Rehabil Eng, 2022, 30: 455-464..
5. Hamano Y H, Sugawara S K, Fukunaga M, et al. The integrative role of the M1 in motor sequence learning. Neurosci Lett, 2021, 760: 136081..
6. Veldema J, Gharabaghi A. Non-invasive brain stimulation for improving gait, balance, and lower limbs motor function in stroke. J Neuroeng Rehabil, 2022, 19(1): 84..
7. Elyamany O, Leicht G, Herrmann C S, et al. Transcranial alternating current stimulation (tACS): from basic mechanisms towards first applications in psychiatry. Eur Arch Psychiatry Clin Neurosci, 2021, 271(1): 135-156..
8. Antal A, Paulus W. Transcranial alternating current stimulation (tACS). Front Hum Neurosci, 2013, 7: 317..
9. 張學軍, 李菲. 經顱交流電刺激對運動技能學習與鞏固的作用. 科學技術與工程, 2022, 22(27): 11850-11857..
10. Di Rienzo F, Debarnot U, Daligault S, et al. Online and offline performance gains following motor imagery practice: a comprehensive review of behavioral and neuroimaging studies. Front Hum Neurosci, 2016, 10: 315..
11. 王建華, 陳蘇英, 王飛, 等. 運動想象的神經機制及其在偏癱康復應用中的研究進展. 中華物理醫學與康復雜志, 2021, 43(2): 184-186..
12. Diaz Hernandez L, Rieger K, Baenninger A, et al. Towards using microstate-neurofeedback for the treatment of psychotic symptoms in schizophrenia. A feasibility study in healthy participants. Brain Topography, 2016, 29(2): 308-321..
13. Damborská A, Piguet C, Aubry J M, et al. Altered Electroencephalographic resting-state large-scale brain network dynamics in euthymic bipolar disorder patients. Front Psychiatry, 2019, 10: 826..
14. Yan Y, Gao M, Geng Z, et al. Abnormal EEG microstates in Alzheimer's disease: predictors of β-amyloid deposition degree and disease classification. Geroscience, 2024, 46(5): 4779-4792..
15. Guo Y, Zhao X, Liu X, et al. Electroencephalography microstates as novel functional biomarkers for insomnia disorder. Gen Psychiatr, 2023, 36(6): e101171..
16. Khanna A, Pascual-Leone A, Michel C M, et al. Microstates in resting-state EEG: current status and future directions. Neurosci Biobehav Rev, 2015, 49: 105-113..
17. 辛榕, 余賢嫻, 程斯曼, 等. 基于腦電微狀態和表面肌電觀察重復經顱磁刺激對腦卒中后右側偏癱患者上肢運動功能的影響. 中華物理醫學與康復雜志, 2024, 46(9): 791-798..
18. 王海力, 尹寧, 徐桂芝. 腦電圖微狀態分析及應用研究進展. 生物醫學工程學雜志, 2023, 40(1): 163-170..
19. Xiong X, Ji X, Yi S, et al. Motor imagery EEG microstates are influenced by alpha power. Comput Methods Biomech Biomed Engin, 2025: 1-16..
20. Milz P, Faber P L, Lehmann D, et al. The functional significance of EEG microstates-Associations with modalities of thinking. Neuroimage, 2016, 125: 643-656..
21. Bréchet L, Brunet D, Birot G, et al. Capturing the spatiotemporal dynamics of self-generated, task-initiated thoughts with EEG and fMRI. Neuroimage, 2019, 194: 82-92..
22. Antonova E, Holding M, Suen H C, et al. EEG microstates: Functional significance and short-term test-retest reliability. Neuroimage Rep, 2022, 2(2): 100089..
23. Jabès A, Klencklen G, Ruggeri P, et al. Resting-state EEG microstates parallel age-related differences in allocentric spatial working memory performance. Brain Topogr, 2021, 34(4): 442-460..
24. Seitzman B A, Abell M, Bartley S C, et al. Cognitive manipulation of brain electric microstates. Neuroimage, 2017, 146: 533-543..
25. Du M, Peng Y, Li Y, et al. Effect of trait anxiety on cognitive flexibility: evidence from event-related potentials and resting-state EEG. Biol Psychol, 2022, 170: 108319..
26. Chen X, Chen N X, Shen Y Q, et al. The subsystem mechanism of default mode network underlying rumination: A reproducible neuroimaging study. Neuroimage, 2020, 221: 117185..
27. Vellante F, Ferri F, Baroni G, et al. Euthymic bipolar disorder patients and EEG microstates: a neural signature of their abnormal self experience?. J Affect Disord, 2020, 272: 326-334..
28. D'Croz-Baron D F, Bréchet L, Baker M, et al. Auditory and visual tasks influence the temporal dynamics of EEG microstates during post-encoding rest. Brain Topogr, 2021, 34(1): 19-28..
29. Kim K, Duc N T, Choi M, et al. EEG microstate features according to performance on a mental arithmetic task. Sci Rep, 2021, 11(1): 343..
30. Wang L, Ding X, Zhang W, et al. Differences in EEG microstate induced by gaming: a comparison between the gaming disorder individual, recreational game users and healthy controls. IEEE Access, 2021, 9: 32549-32558..
31. Murphy M, Stickgold R, Parr M E, et al. Recurrence of task-related electroencephalographic activity during post-training quiet rest and sleep. Sci Rep, 2018, 8(1): 5398..
32. Xue S, Shen X, Zhang D, et al. Unveiling frequency-specific microstate correlates of anxiety and depression symptoms. Brain Topogr, 2025, 38(1): 12..
33. Shi W, Li Y, Liu Z, et al. Non-canonical microstate becomes salient in high density EEG during propofol-induced altered states of consciousness. Int J Neural Syst. 2020, 30(2): 2050005..
34. Tomescu M I, Papasteri C C, Sofonea A, et al. Spontaneous thought and microstate activity modulation by social imitation. Neuroimage, 2022, 249: 118878..
35. Poskanzer C, Denis D, Herrick A, et al. Using EEG microstates to examine post-encoding quiet rest and subsequent word-pair memory. Neurobiol Learn Mem, 2021, 181: 107424..
36. 楊曉明, 劉陽, 王建華, 等. 慢性高原病患者默認網絡改變: 基于后扣帶回的功能連接研究. 磁共振成像, 2016, 7(2): 107-112..
37. Ke M, Li J, Wang L. Alteration in resting-state EEG microstates following 24 hours of total sleep deprivation in healthy young male subjects. Front Hum Neurosci, 2021, 15: 636252..
38. Tarailis P, ?imkut? D, Koenig T, et al. Relationship between spatiotemporal dynamics of the brain at rest and self-reported spontaneous thoughts: an EEG microstate approach. J Pers Med, 2021, 11(11): 1216..
39. Baldini S, Sartori A, Rossi L, et al. Fatigue in multiple sclerosis: a resting-state EEG microstate study. Brain Topogr. 2024, 37(6): 1203-1216..
40. Li D, Liu R, Ye F, et al. Modulation of brain function and antidepressant effects by transcranial alternating current stimulation in patients with major depressive disorder: Evidence from ERP. J Psychiatr Res. 2024, 176: 1-8..
41. San-Juan D, Espinoza-López D A, Vázquez-Gregorio R, et al. A pilot randomized controlled clinical trial of transcranial alternating current stimulation in patients with multifocal pharmaco-resistant epilepsy. Epilepsy Behav. 2022, 130: 108676..

Journal of Biomedical Engineering

Microstate dynamics in motor imagery of stroke patients with transcranial alternating current stimulation modulation

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