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. 2023 Dec;37(11-12):837-849.
doi: 10.1177/15459683231209722. Epub 2023 Nov 10.

Applications of Repetitive Transcranial Magnetic Stimulation to Improve Upper Limb Motor Performance After Stroke: A Systematic Review

Afifa Safdar  1 , Marie-Claire Smith  2 , Winston D Byblow  2 , Cathy M Stinear  1
Affiliations

Applications of Repetitive Transcranial Magnetic Stimulation to Improve Upper Limb Motor Performance After Stroke: A Systematic Review

Afifa Safdar et al. Neurorehabil Neural Repair. 2023 Dec.

Abstract

Background: Noninvasive brain stimulation (NIBS) is a promising technique for improving upper limb motor performance post-stroke. Its application has been guided by the interhemispheric competition model and typically involves suppression of contralesional motor cortex. However, the bimodal balance recovery model prompts a more tailored application of NIBS based on ipsilesional corticomotor function.

Objective: To review and assess the application of repetitive transcranial magnetic stimulation (rTMS) protocols that aimed to improve upper limb motor performance after stroke.

Methods: A PubMed search was conducted for studies published between 1st January 2005 and 1st November 2022 using rTMS to improve upper limb motor performance of human adults after stroke. Studies were grouped according to whether facilitatory or suppressive rTMS was applied to the contralesional hemisphere.

Results: Of the 492 studies identified, 70 were included in this review. Only 2 studies did not conform to the interhemispheric competition model, and facilitated the contralesional hemisphere. Only 21 out of 70 (30%) studies reported motor evoked potential (MEP) status as a biomarker of ipsilesional corticomotor function. Around half of the studies (37/70, 53%) checked whether rTMS had the expected effect by measuring corticomotor excitability (CME) after application.

Conclusion: The interhemispheric competition model dominates the application of rTMS post-stroke. The majority of recent and current studies do not consider bimodal balance recovery model for the application of rTMS. Evaluating CME after the application rTMS could confirm that the intervention had the intended neurophysiological effect. Future studies could select patients and apply rTMS protocols based on ipsilesional MEP status.

Keywords: motor evoked potentials; noninvasive brain stimulation; stroke; theta burst stimulation; transcranial magnetic stimulation.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Of the 492 studies published from January 2005 to November 2022, 70 studies were included in this review that applied rTMS over the contralesional hemisphere to improve upper limb function after stroke.
Figure 2.
Figure 2.
Distribution of studies according to the pattern of application of rTMS. One study suppressed the contralesional hemisphere in 1 session and facilitated it in another session, so it is included in both categories of contralesional suppression and contralesional facilitation.
Figure 3.
Figure 3.
Number of studies published from January 2005 to November 2022 that applied rTMS over the contralesional hemisphere to improve upper limb function after stroke.
Figure 4.
Figure 4.
Number of studies published from January 2005 to November 2022 grouped according to time after stroke that applied rTMS over the contralesional hemisphere to improve upper limb function.
Figure 5.
Figure 5.
Scatter plot of sample size for studies published from January 2005 to November 2022 that applied rTMS over the contralesional hemisphere to improve upper limb function after stroke. Note. The dashed horizontal line represents the median sample size, n = 20.
Figure 6.
Figure 6.
Distribution of current studies that plan to apply rTMS to improve hand function after stroke. The numbers in each box are clinical trial registration numbers from clinicaltrials.gov website.
See this image and copyright information in PMC

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