Abstract
Background and Objectives: Repetitive transcranial magnetic stimulation (rTMS) is being widely used for treating upper extremity paresis after stroke, however, evidence of applying high-frequency rTMS (HF-rTMS) on the ipsilesional hemisphere for upper extremity motor recovery remains limited. This systematic review aimed to investigate the effect of high-frequency repetitive transcranial magnetic stimulation for upper extremity motor function recovery after a first-time ischaemic stroke. Materials and Methods: This systematic review was prepared according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive literature search was performed to identify all studies published before 12 February 2021. The search was performed on the following databases: PubMed, Ovid, The Cochrane Library. Results: A total of 6440 studies were found in the databases and four trials were included in the review. Three of the studies were randomized control trials (RCT), and one was a pseudo-RCT. Three of the studies showed good methodological quality and one study was rated as excellent. Fugl-Meyer Assessment (FMA) was performed in three out of four studies and the score significantly increased in the HF-rTMS treatment group compared with sham stimulation in all trials. Other measures used in the studies were handgrip strength, shoulder abduction, Motricity Index, Wolf Motor Function Test (WMFT), and Box and Block, although these tests did not show unanimous results. Overall, all four studies conveyed significantly better results in at least one test that was performed for hand motor function evaluation in a 10 Hz stimulation group while none of the tests showed any advantage for sham stimulation groups. Two studies reported headache as an adverse event (six patients in total). Conclusion: The overall results showed that HF-rTMS may increase impaired upper extremity motor function better than sham stimulation in stroke patients.
Highlights
Despite the growing knowledge about etiology and risk factors, stroke remains the leading cause of serious long-term adult disability worldwide [1,2]
A total of 3 studies were excluded because a frequency other than 10 Hz repetitive transcranial magnetic stimulation (rTMS) was used [17,18,19], one study was excluded because included patients experienced haemorrhagic and non-ischemic stroke [20], one study was not randomized control trials (RCT) [21], and one study did not compare rTMS and sham stimulation groups with each other [22]
To evaluate the efficacy of high-frequency (10 Hz) rTMS for upper extremity motor function recovery after ischemic stroke, Fugl-Meyer Assessment (FMA)-UL, Wolf Motor Function Test (WMFT), Motricity Index arm score (MI-A), Box and Block test (BBT), the strength of handgrip, and shoulder abduction testing were performed in included trials [23,24,25,26]
Summary
Despite the growing knowledge about etiology and risk factors, stroke remains the leading cause of serious long-term adult disability worldwide [1,2]. Half of the stroke survivors with plegic or paretic upper extremity regain useful hand movements within six months after stroke [5] An improvement of this function has a positive significant effect on the quality of life of stroke patients, resulting in decreased economic and caregiver burdens [2]. This systematic review aimed to investigate the effect of high-frequency repetitive transcranial magnetic stimulation for upper extremity motor function recovery after a first-time ischaemic stroke. All four studies conveyed significantly better results in at least one test that was performed for hand motor function evaluation in a 10 Hz stimulation group while none of the tests showed any advantage for sham stimulation groups. Conclusion: The overall results showed that HF-rTMS may increase impaired upper extremity motor function better than sham stimulation in stroke patients
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