Abstract
Background and Purpose This meta-analysis aimed to evaluate the therapeutic potential of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the contralesional hemisphere on upper limb motor recovery and cortex plasticity after stroke. Methods Databases of PubMed, Medline, ScienceDirect, Cochrane, and Embase were searched for randomized controlled trials published before Jun 31, 2017. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI). Resting motor threshold (rMT) and motor-evoked potential (MEP) were also examined. Results Twenty-two studies of 1 Hz LF-rTMS over the contralesional hemisphere were included. Significant efficacy was found on finger flexibility (SMD = 0.75), hand strength (SMD = 0.49), and activity dexterity (SMD = 0.32), but not on body function (SMD = 0.29). The positive changes of rMT (SMD = 0.38 for the affected hemisphere and SMD = −0.83 for the unaffected hemisphere) and MEP (SMD = −1.00 for the affected hemisphere and SMD = 0.57 for the unaffected hemisphere) were also significant. Conclusions LF-rTMS as an add-on therapy significantly improved upper limb functional recovery especially the hand after stroke, probably through rebalanced cortical excitability of both hemispheres. Future studies should determine if LF-rTMS alone or in conjunction with practice/training would be more effective. Clinical Trial Registration Information This trial is registered with unique identifier CRD42016042181.
Highlights
Stroke is a global disease with high rates of long-term disability [1]
This meta-analysis aimed to evaluate the therapeutic potential of low-frequency repetitive transcranial magnetic stimulation (LF-Repetitive transcranial magnetic stimulation (rTMS)) over the contralesional hemisphere on upper limb motor recovery and cortex plasticity after stroke
The results showed a significant enhancing effect of motor-evoked potential (MEP) in the affected hemisphere (SMD = 0.38, 95% confidence interval (CI) = 0.02–0.74; P = 0 04) without heterogeneity (I2 = 0%) (Figure 4(a)) and a highly significant suppressing effect of MEP in the unaffected hemisphere (SMD = −0.83, 95% CI = −1.13 to −0.54; P < 0 0001), without significant heterogeneity (I2 = 18%) (Figure 4(b))
Summary
Stroke is a global disease with high rates of long-term disability [1]. Around the world, 25%–74% of stroke survivors require different levels of assistance for daily living mainly due to upper limb hemiplegia [2]. In search for better therapies, scientists have been trying to understand the relationship between stroke motor recovery and cortical reorganization [3]. RTMS is being explored as a novel therapy in modulating cortical excitability to improve motor functions in stroke patients [5]. Of the two forms of rTMS, high-frequency rTMS (HF-rTMS > 1.0 Hz), applied over the ipsilesional hemisphere, facilitates cortical excitability [6], whereas, low-frequency rTMS (LF-rTMS ≤ 1.0 Hz), applied over the contralesional hemisphere, decreases cortical excitability [7] This meta-analysis aimed to evaluate the therapeutic potential of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the contralesional hemisphere on upper limb motor recovery and cortex plasticity after stroke. LF-rTMS as an add-on therapy significantly improved upper limb functional recovery especially the hand after stroke, probably through rebalanced cortical excitability of both hemispheres.
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