Effects of 10 ㎐ High Frequency Repetitive Transcranial Magnetic Stimulation Combined with Somatosensory Training for Recovery of Upper Limb Motor and Hand Function in Chronic Stroke Patients

Effects of repetitive transcranial magnetic stimulation on sequelae in patients with chronic stroke: A systematic review and meta-analysis of randomized controlled trials

“…A total of 9 of the 27 studies used 1 Hz rTMS (Fregni et al, 2006 ; Wang et al, 2012 ; Higgins et al, 2013 ; Barros Galvão et al, 2014 ; Rose et al, 2014 ; Vongvaivanichakul et al, 2014 ; Askin et al, 2017 ; Dos Santos et al, 2019 ; Kuzu et al, 2021 ) with 600-1,500 pulses per session. Nine studies used high frequency rTMS ranging from 5 Hz (900 pulses) (Wang et al, 2019 ; Lee and Cha, 2020 ), 10 Hz (700-3,000 pulses) (de Oliveira et al, 2014 ; Gu and Chang, 2017 ; Sasaki et al, 2017 ; Jeong et al, 2020 ; Liu et al, 2020 ; Hordacre et al, 2021 ) to 20 Hz (2,000 pulses) (Malcolm et al, 2007 ). Nine studies used TBS with frequencies ranging from intermittent TBS (600-1,200 pulses) (Ackerley et al, 2016 ; Chen et al, 2019 ; Koch et al, 2019 ; Lin et al, 2019 ; Zhang et al, 2022 ), continuous TBS (600 pulses) (Di Lazzaro et al, 2013 , 2016 ; Kuzu et al, 2021 ) to a combination of continuous and intermittent TBS (600 pulses) (Zhang et al, 2022 ).…”

“…Nine studies used TBS with frequencies ranging from intermittent TBS (600-1,200 pulses) (Ackerley et al, 2016 ; Chen et al, 2019 ; Koch et al, 2019 ; Lin et al, 2019 ; Zhang et al, 2022 ), continuous TBS (600 pulses) (Di Lazzaro et al, 2013 , 2016 ; Kuzu et al, 2021 ) to a combination of continuous and intermittent TBS (600 pulses) (Zhang et al, 2022 ). Almost all studies used sham coils, tilt coils, 20% RMT stimulation intensity or sham coils without stimulator output for sham stimulation, one study (Askin et al, 2017 ) had no sham rTMS, and one study (Jeong et al, 2020 ) did not describe the details of sham rTMS.…”

“…Pooled data from 15 studies (Malcolm et al, 2007 ; Higgins et al, 2013 ; Barros Galvão et al, 2014 ; Rose et al, 2014 ; Vongvaivanichakul et al, 2014 ; Ackerley et al, 2016 ; Di Lazzaro et al, 2016 ; Askin et al, 2017 ; Gu and Chang, 2017 ; Chen et al, 2019 ; Jeong et al, 2020 ; Kuzu et al, 2021 ; Zhang et al, 2022 ) was employed to determine the effects of rTMS on the upper extremity movement in chronic stroke patients, and low-quality evidence showed results that demonstrated a significant improvement in the treatment group (SMD: 0.49; 95% CI: 0.08–0.89; P = 0.019) ( Figure 2 ), but relatively high heterogeneity ( I 2 = 63.9%, P < 0.001). Regarding the effect of rTMS on hand function, pooled data from six studies (Fregni et al, 2006 ; Malcolm et al, 2007 ; Di Lazzaro et al, 2013 ; Higgins et al, 2013 ; Askin et al, 2017 ; Chen et al, 2019 ) was used, and moderate quality evidence observed a significant improvement in the treatment group (SMD: 0.45; 95% CI: 0.08-0.83; P = 0.017) ( Figure 3 ), with 0% heterogeneity.…”

“…Criteria numbers: 1, eligibility criteria; 2, random allocation; 3, concealed allocation; 4, similar groups at baseline; 5, blinding subjects; 6, blinding therapists; 7, blinding assessors; 8, outcome obtained in more than 85% of the subjects; 9, intention-to-treat analysis; 10, between-group statistical comparisons; 11, point estimates and measures of variability. Oliveira et al, 2014;Gu and Chang, 2017;Sasaki et al, 2017;Jeong et al, 2020;Liu et al, 2020;Hordacre et al, 2021) to 20 Hz (2,000 pulses) (Malcolm et al, 2007). Nine studies used TBS with frequencies ranging from intermittent TBS (600-1,200 pulses) (Ackerley et al, 2016;Chen et al, 2019;Koch et al, 2019;Lin et al, 2019;Zhang et al, 2022), continuous TBS (600 pulses) (Di Lazzaro et al, 2013Lazzaro et al, , 2016Kuzu et al, 2021) to a combination of continuous and intermittent TBS (600 pulses) (Zhang et al, 2022).…”

“…Pooled data from 15 studies (Malcolm et al, 2007;Higgins et al, 2013;Barros Galvão et al, 2014;Rose et al, 2014;Vongvaivanichakul et al, 2014;Ackerley et al, 2016;Di Lazzaro et al, 2016;Askin et al, 2017;Gu and Chang, 2017;Chen et al, 2019;Jeong et al, 2020;Kuzu et al, 2021;Zhang et al, 2022) was employed to determine the effects of rTMS on the upper extremity movement in chronic stroke patients, and low-quality evidence showed results that demonstrated a significant improvement in the treatment group (SMD: 0.49; 95% CI: 0.08-0.89; P = 0.019) (Figure 2), but relatively high heterogeneity (I² = 63.9%, P < 0.001).…”