Systematic review and meta-analysis of the efficacy of repetitive transcranial magnetic stimulation on post-stroke limb spasticity.

BACKGROUND

Post-stroke spasticity significantly impairs motor function in patients. Repetitive transcranial magnetic stimulation (rTMS), including conventional rTMS and its patterned protocols such as continuous and intermittent theta-burst stimulation (cTBS/iTBS), has been widely investigated as a promising noninvasive neuromodulation technique to promote motor recovery after stroke. However, the efficacy of rTMS in treating post-stroke spasticity remains unclear. Therefore, this study aims to evaluate the therapeutic effects of rTMS on post-stroke spasticity through a meta-analysis.

METHODS

A comprehensive search was conducted for randomized-controlled trials (RCTs) published between January 1, 2010, and July 1, 2025, in the Embase, Cochrane Library, and PubMed databases. The inclusion criteria were post-stroke patients with a baseline modified Ashworth Scale (MAS) score of ≥ 1, indicating the presence of spasticity. The interventions of interest were repetitive transcranial magnetic stimulation (rTMS) or intermittent/transient theta-burst stimulation (iTBS/cTBS), with the primary outcome measure being the MAS score. Cochran's Q test and the I2 statistic were used to assess heterogeneity between studies, and a random-effects model was applied for data synthesis.

RESULTS

A total of 12 RCTs were included in the analysis. The meta-analysis results demonstrated that, compared to the control group, rTMS interventions significantly reduced the MAS score, with a pooled mean difference (MD) of -0.51 (95% confidence interval [CI]: - 0.66 to - 0.36, p < 0.00001). Sensitivity analysis using the leave-one-out method confirmed the robustness of this result. Subgroup analysis indicated that the therapeutic effects of rTMS were consistent across different stimulation protocols (LF-rTMS, iTBS/cTBS), target areas (contralateral M1 region, other brain areas), and stages of stroke (subacute, chronic). Meta-regression analysis revealed that the total number of treatment pulses was not a significant source of heterogeneity, nor was it significantly correlated with treatment efficacy.

CONCLUSIONS

rTMS is a promising adjunctive intervention for post-stroke limb spasticity, with its efficacy confirmed across various stimulation parameters and patient populations. However, no significant effect of the total number of treatment pulses on therapeutic outcomes was identified.