A Meta-Analysis: Whether Repetitive Transcranial Magnetic Stimulation Improves Dysfunction Caused by Stroke with...

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Clinical Trials

Background:

• Stroke frequently leads to lower limb spasticity, impairing motor function and daily living activities.
• Current treatments for post-stroke spasticity have limitations, necessitating exploration of novel therapeutic approaches.
• Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique with potential therapeutic applications in neurological recovery.

Purpose of the Study:

• To systematically evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in improving lower limb spasticity and related functional outcomes in patients following a stroke.
• To differentiate the effects of low-frequency rTMS (LF-rTMS) and high-frequency rTMS (HF-rTMS) on motor function and spasticity.
• To assess the impact of rTMS on activities of daily living in the post-stroke population.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, CBM, VIP, Wanfang) up to May 2021.
• Randomized controlled trials (RCTs) investigating rTMS for lower extremity spasticity post-stroke were included. Data extraction and quality assessment were performed using standard guidelines (Cochrane Handbook, PE-Dro scale).
• Systematic analysis of valid data from nine studies involving 554 patients was performed using Review Manager 5.4 software, focusing on outcomes like MAS, FMA-LE, MBI, and TUG.

Main Results:

• rTMS significantly reduced spasticity as measured by the Modified Ashworth Scale (MAS) and improved scores on the Modified Barthel Index (MBI), indicating better daily living activities.
• Low-frequency rTMS (LF-rTMS) demonstrated a significant positive effect on enhancing motor function, as evidenced by improved Fugl-Meyer Assessment of Lower Extremity (FMA-LE) scores.
• No significant improvements were observed in FMA-LE scores with high-frequency rTMS (HF-rTMS) or in Timed Up and Go (TUG) test results between treatment and control groups.

Conclusions:

• Repetitive transcranial magnetic stimulation (rTMS) is an effective intervention for improving lower limb spasticity and enhancing activities of daily living in stroke survivors.
• Low-frequency rTMS (LF-rTMS) shows particular promise for improving motor function in patients with post-stroke lower extremity spasticity.
• Further high-quality, multicenter, double-blind randomized controlled trials are warranted to robustly validate these findings and optimize rTMS protocols for stroke rehabilitation.