Repetitive transcranial magnetic stimulation for freezing of gait in Parkinson's disease: a systematic review and meta-analysis.

BACKGROUND

Freezing of gait is among the most disabling motor complications of Parkinson's disease, markedly increasing fall risk and reducing quality of life. Repetitive transcranial magnetic stimulation has emerged as a non-invasive neuromodulation approach; however, evidence regarding its efficacy for freezing of gait remains heterogeneous and inconclusive.

OBJECTIVES

To evaluate the efficacy and safety of repetitive transcranial magnetic stimulation for freezing of gait and motor outcomes in Parkinson's disease.

METHODS

A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (PROSPERO: CRD420261285716). PubMed, Scopus, Cochrane Library, and Web of Science were searched through January 2026 for randomized controlled trials. The primary outcome was freezing of gait severity measured by the Freezing of Gait Questionnaire. Pooled standardized mean differences were calculated using random-effects modeling.

RESULTS

Twelve randomized controlled trials comprising 293 participants were included. Repetitive transcranial magnetic stimulation significantly improved freezing of gait severity as measured by the Freezing of Gait Questionnaire (standardized mean difference = -0.97, 95% confidence interval - 1.39 to -0.55; p < 0.001). Significant improvements were also observed in motor function, Timed Up and Go performance, gait speed, step/stride length, turn time, and turn steps, whereas cadence did not differ significantly. No serious adverse events were reported.

CONCLUSIONS

Repetitive transcranial magnetic stimulation significantly improves freezing of gait and motor performance in Parkinson's disease, representing a safe and promising adjunctive therapy for gait disturbances refractory to conventional treatment. Future large-scale trials with standardized protocols are needed to confirm long-term efficacy.