Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
Efficacy of repetitive transcranial magnetic stimulation for post-stroke spasticity: a meta-analysis of randomized controlled trials.
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Wang Yage, Liu Taojie, Lei Beibei, Wang Ming, Chen Liangsheng, Wang Heling, Zhang Di, Ma Shenhong, Han Qiaohua, Liu Shaowen, Yang Jiayin, Zhuang Weisheng
Аннотация
OBJECTIVE: This study aimed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) for improving spasticity, motor function, and activities of daily living (ADL) in patients with post-stroke spasticity (PSS), and to perform a comprehensive analysis of key factors related to its therapeutic effect.
METHODS: Relevant randomized controlled trials (RCTs) were retrieved from four databases. Meta-analysis was conducted using RevMan, and the quality of evidence was assessed with the GRADEpro tool.
RESULTS: Overall, 13 studies (encompassing 18 RCTs) were included. The results demonstrated that rTMS alleviated PSS (MD = - 0.23, 95% CI: -0.43 to - 0.02, P = 0.03) and improved motor (MD = 2.46, 95% CI: 1.54 to 3.38, P < 0.00001), whereas it showed no significant effect on ADL (SMD = 0.31, 95% CI: -0.06 to 0.67, P = 0.10). For spasticity, stimulating the unaffected hemisphere achieved significantly better efficacy (SMD = -0.19, 95% CI: -0.37 to -0.00, P = 0.05), and combined high and low frequency rTMS showed promising effects (SMD = -0.65, 95% CI: -0.94 to -0.36, P < 0.00001). For motor function, rTMS yielded greater improvement in upper limb PSS patients (SMD = 3.58, 95% CI: 2.18 to 4.98, P < 0.00001). Within a certain range, pulse number was positively correlated with motor improvement (β = 2.46, 95% CI: 0.097 to 4.81, P = 0.043).
CONCLUSION: Moderate to high quality evidence demonstrates that rTMS can potentially alleviate PSS and improve motor function in patients, whereas its efficacy in improving ADL remains unclear, with very low quality of evidence. In addition, stimulation frequency, stimulation site, pulse number, and affected site are key moderators of rTMS efficacy. These findings guide the clinical optimization of rTMS regimens, and future research is required to identify specific parameter thresholds.
METHODS: Relevant randomized controlled trials (RCTs) were retrieved from four databases. Meta-analysis was conducted using RevMan, and the quality of evidence was assessed with the GRADEpro tool.
RESULTS: Overall, 13 studies (encompassing 18 RCTs) were included. The results demonstrated that rTMS alleviated PSS (MD = - 0.23, 95% CI: -0.43 to - 0.02, P = 0.03) and improved motor (MD = 2.46, 95% CI: 1.54 to 3.38, P < 0.00001), whereas it showed no significant effect on ADL (SMD = 0.31, 95% CI: -0.06 to 0.67, P = 0.10). For spasticity, stimulating the unaffected hemisphere achieved significantly better efficacy (SMD = -0.19, 95% CI: -0.37 to -0.00, P = 0.05), and combined high and low frequency rTMS showed promising effects (SMD = -0.65, 95% CI: -0.94 to -0.36, P < 0.00001). For motor function, rTMS yielded greater improvement in upper limb PSS patients (SMD = 3.58, 95% CI: 2.18 to 4.98, P < 0.00001). Within a certain range, pulse number was positively correlated with motor improvement (β = 2.46, 95% CI: 0.097 to 4.81, P = 0.043).
CONCLUSION: Moderate to high quality evidence demonstrates that rTMS can potentially alleviate PSS and improve motor function in patients, whereas its efficacy in improving ADL remains unclear, with very low quality of evidence. In addition, stimulation frequency, stimulation site, pulse number, and affected site are key moderators of rTMS efficacy. These findings guide the clinical optimization of rTMS regimens, and future research is required to identify specific parameter thresholds.