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Review
. 2025 Apr;46(4):1525-1539.
doi: 10.1007/s10072-024-07918-6. Epub 2024 Dec 21.

Intermittent theta burst stimulation vs. high-frequency repetitive transcranial magnetic stimulation for post-stroke dysfunction: a Bayesian model-based network meta-analysis of RCTs

Yanbing Huang  1 , Caihui Li  1 , Rongda Cai  1 , Tianlai Lin  2   3 , Weiwen Chen  4   5
Affiliations
Review

Intermittent theta burst stimulation vs. high-frequency repetitive transcranial magnetic stimulation for post-stroke dysfunction: a Bayesian model-based network meta-analysis of RCTs

Yanbing Huang et al. Neurol Sci. 2025 Apr.

Abstract

Objective: This research aims to comprehensively assess the efficacy of intermittent theta-burst stimulation (iTBS) vs. high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in post-stroke dysfunction.

Materials and methods: Until January 2024, extensive electronic database searches were conducted (PubMed, Embase, Cochrane Library, Web of Science, etc.). Fugl-Meyer Assessment for Upper Extremities (FMA-UE) was used to assess upper limb (UL) dysfunction; post-stroke dysphagia (PSD) was identified by Standardized Swallowing Assessment (SSA), Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), and Penetration/Aspiration Scale (PAS). Results were analyzed by network meta-analysis (NMA), and the mean difference (MD) and 95% confidence intervals (95% CI) were also reported. We conducted a descriptive analysis due to the inability to synthesize data on post-stroke cognitive impairment (PSCI).

Results: 19 studies were included for NMA analysis. For UL disorder, the efficacy of treatments was ranked as HF-rTMS [MD (95%CI):3.00 (1.69,4.31)], iTBS [MD (95%CI): 2.16 (0.84, 3.50)], and sham stimulation (reference). For PSD, the efficacy of treatment to reduce scores of FEDSS or SSA were iTBS [FEDSS, MD (95%CI): -0.80 (-1.13, -0.47); SSA, MD (95%CI): -3.37 (-4.36, -2.38)], HF-rTMS [FEDSS, MD (95%CI): -0.43 (-0.76, -0.10); SSA, MD (95%CI): -2.62 (-3.91, -1.35)], and sham stimulation(reference). Descriptive analysis of PSCI found that both iTBS and HF-rTMS were effective in improving PSCI.

Conclusions: HF-rTMS demonstrates superior efficacy in UL dysfunction, while iTBS is more effective in PSD. Clinicians should carefully evaluate the type and severity of post-stroke dysfunction in each patient to select the most appropriate treatment.

Keywords: HF-rTMS; Network meta-analysis; Post-stroke dysfunction; iTBS.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable, our study is based on open-source public database, and the Quanzhou First Hospital Affiliated to Fujian Medical University do not require research using publicly available data to be submitted for review to their ethics committee, so there are no ethical issues and other conflicts of interest. Consent for publication: Not applicable. Conflict of interest: All authors declare that they have no conflict of interests.

Figures

Fig. 1
Fig. 1
The flowchart of the study
Fig. 2
Fig. 2
Geometry of the network. The node size indicates the number of participants in the intervention, while the edge thickness reflects the number of studies for each treatment comparison. (A) FMA-UE; (B) FEDSS; (C)SSA; (D) PAS. FMA-UE, Fugl-Meyer Assessment for Upper Extremities; FEDSS, Fiberoptic Endoscopic Dysphagia Severity Scale; SSA, Standardized Swallowing Assessment; PAS, Penetration/Aspiration Scale
Fig. 3
Fig. 3
Meta-analysis for outcomes. (A) FMA-UE; (B) FEDSS; (C) SSA. FMA-UE, Fugl-Meyer Assessment for Upper Extremities; FEDSS, Fiberoptic Endoscopic Dysphagia Severity Scale; SSA, Standardized Swallowing Assessment
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