Abstract
Objective To evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in improving lower limb spasticity after stroke. Methods The PubMed, Web of Science, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM) disc, China Science and Technology Journal Database (VIP), and Wanfang databases were searched online from their inception to May 2021 for randomized controlled trials (RCTs) involving repetitive transcranial magnetic stimulation for lower extremity spasticity after stroke. Valid data were extracted from the included literature, and the quality evaluation was conducted with the Cochrane Handbook for Systematic Reviews of Interventions along with the Physiotherapy Evidence Database scale (PE-Dro scale). The data that met the quality requirements were systematically analysed using Review Manager 5.4 software. Results A total of 554 patients from seven articles (nine studies) were quantitatively analysed. Outcomes included the Modified Ashworth Scale (MAS), Fugl–Meyer Assessment of Lower Extremity (FMA-LE), Modified Barthel Index (MBI), and Timed Up and Go (TUG), measured as the effect of rTMS compared with controls conditions after treatment. The systematic review showed that rTMS reduced MAS and increased MBI scores, respectively (SMD = −0.24, 95% CI [−0.45, −0.03], P = 0.02; MD = 6.14, 95% CI [−3.93,8.35], P ＜ 0.00001), compared with control conditions. Low-frequency rTMS (LF-rTMS) significantly improved FMA-LE scores (SMD = 0.32, 95% CI [0.13, 0.51], P = 0.001). However, there was no significant difference in FMA-LE scores when using high-frequency rTMS (HF-rTMS) (P > 0.1) and in TUG times (P > 0.1) between the treatment and control groups. Conclusions rTMS was effective in improving spasticity and activities of daily living. LF-rTMS has positive clinical effects on enhancing motor function in patients who experience lower extremity spasticity after stroke. To better validate the above conclusions, more multicentre, high-quality, and double-blind randomized controlled trials are needed.
Highlights
Stroke is a common disease worldwide and causes serious disabilities for patients
We performed a search in the PubMed, Web of Science, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), VIP, and Wanfang databases published up to May 2021. e search terms were “stroke” OR “hemiplegia” OR “cerebrovascular accident” OR “ischemic stroke” OR “hemorrhagic stroke” OR “CVA” OR “apoplexy” AND “repetitive transcranial magnetic stimulation” OR “rTMS” OR “transcranial magnetic stimulation” OR “TMS” AND “spasticity” AND “lower limb” OR “lower extremity”
Inclusion and Exclusion Criteria. e relevant articles were selected based on the following eligibility criteria: (1) the involved patients were clinically diagnosed with lower limb spasticity after stroke by relevant examinations; (2) the experimental group used rTMS and traditional physical therapy, while the control group underwent traditional physical therapy plus sham rTMS; (3) the outcome measures included the Modified Ashworth Scale (MAS), Fugl–Meyer Assessment of Lower Extremity (FMA-LE), Modified Barthel Index (MBI), and Timed Up and Go (TUG); and (4) the included articles were randomized controlled trials (RCTs)
Summary
Stroke is a common disease worldwide and causes serious disabilities for patients. More than two-thirds of stroke survivors develop poststroke sequelae that involve impairment of motor function, balance, gait, and activities of daily living [1, 2]. Current management of poststroke spasticity has shown that drug therapy (such as botulinum toxin injection, oral baclofen, dantrolene, sodium, and tizanidine) is effective for improving spasticity and widely used in clinical practice, it had side effects and produced unsatisfied clinical effects such as muscle weakness [4]. Nondrug therapy, such as neuromuscular electrical stimulation and physical therapy, temporarily relieved poststroke spasticity and motor dysfunction. The purpose of this study was to perform a systematic review of RCTs that explored the efficacy of rTMS in treating patients with lower limb spasticity after stroke
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