Repetitive transcranial magnetic stimulation of primary motor cortex for stroke upper limb motor sequelae rehabilitation: A systematic review

Abstract

BACKGROUND: Repetitive Transcranial Magnetic Stimulation (rTMS) over the primary motor cortex (M1) has been used to treat stroke motor sequelae regulating cortical excitability. Early interventions are widely recommended, but there is also evidence showing interventions in subacute or chronic phases are still useful. OBJECTIVE: To synthetize the evidence of rTMS protocols to improve upper limb motor function in people with subacute and/or chronic stroke. METHODS: Four databases were searched in July 2022. Clinical trials investigating the effectiveness of different rTMS protocols on upper limb motor function in subacute or chronic phases post-stroke were included. PRISMA guidelines and PEDro scale were used. RESULTS: Thirty-two studies representing 1137 participants were included. Positive effects of all types of rTMS protocols on upper limb motor function were found. These effects were heterogeneous and not always clinically relevant or related to neurophysiological changes but produced evident changes if evaluated with functional tests. CONCLUSION: rTMS interventions over M1 are effective for improving upper limb motor function in people with subacute and chronic stroke. When rTMS protocols were priming physical rehabilitation better effects were achieved. Studies considering minimal clinical differences and different dosing will help to generalize the use of these protocols in clinical practice.

Update on Non-invasive Brain Stimulation on Stroke Motor Impairment: A Narrative Review

“…A recent systematic review covering 32 studies with 1,137 participants demonstrated that rTMS over the M1 cortex showed positive functional improvements in upper limb motor function in patients with subacute and chronic stroke patients [ 8 ]. Studies examining the application of LF-rTMS on the unaffected hemisphere, HF-rTMS on the affected hemisphere, and bilateral stimulation were included in the review.…”

Impact of Shaking Exercise on Functional Recovery in Patients with Chronic Post-Stroke Upper Limb Paralysis: A Multicenter, Open-Label, Quasi-Randomized Controlled Trial

“…Recent advancements in noninvasive cerebral stimulation therapies such as repetitive transcranial magnetic stimulation (rTMS) combined with intensive upper limb training have shown promise in improving functions previously considered irreversible [4,[17][18][19][20][21]. Despite these advancements, the accessibility of innovative treatments in home settings remains limited, which poses a significant barrier to sustaining patient engagement and recovery.…”