Effects of High-Frequency (HF) Repetitive Transcranial Magnetic Stimulation (rTMS) on Upper Extremity Motor Function in Stroke Patients: A Systematic Review

Abstract

Background and Objectives: Repetitive transcranial magnetic stimulation (rTMS) is being widely used for treating upper extremity paresis after stroke, however, evidence of applying high-frequency rTMS (HF-rTMS) on the ipsilesional hemisphere for upper extremity motor recovery remains limited. This systematic review aimed to investigate the effect of high-frequency repetitive transcranial magnetic stimulation for upper extremity motor function recovery after a first-time ischaemic stroke. Materials and Methods: This systematic review was prepared according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive literature search was performed to identify all studies published before 12 February 2021. The search was performed on the following databases: PubMed, Ovid, The Cochrane Library. Results: A total of 6440 studies were found in the databases and four trials were included in the review. Three of the studies were randomized control trials (RCT), and one was a pseudo-RCT. Three of the studies showed good methodological quality and one study was rated as excellent. Fugl-Meyer Assessment (FMA) was performed in three out of four studies and the score significantly increased in the HF-rTMS treatment group compared with sham stimulation in all trials. Other measures used in the studies were handgrip strength, shoulder abduction, Motricity Index, Wolf Motor Function Test (WMFT), and Box and Block, although these tests did not show unanimous results. Overall, all four studies conveyed significantly better results in at least one test that was performed for hand motor function evaluation in a 10 Hz stimulation group while none of the tests showed any advantage for sham stimulation groups. Two studies reported headache as an adverse event (six patients in total). Conclusion: The overall results showed that HF-rTMS may increase impaired upper extremity motor function better than sham stimulation in stroke patients.

Effects of repetitive transcranial magnetic stimulation on upper-limb and finger function in stroke patients: A systematic review and meta-analysis of randomized controlled trials

“…With respect to rTMS stimulation frequency, in former studies (65,67), high-frequency rTMS (>1 Hz) and lowfrequency rTMS (≤1 Hz) were found to produce equally significant effects, and high-frequency rTMS was found to induce greater functional recovery of the upper limb than sham stimulation. We further investigated the appropriate frequency for patients in different phases of stroke; on subgroup analysis, 1 Hz and 3-10 Hz rTMS showed equally significant effects in the acute phase of stroke, while 1 Hz and 20 Hz rTMS had more significant effects than 3-10 Hz rTMS in the subacute phase of stroke, and 1 Hz rTMS had better effects than 3-10 Hz rTMS in the chronic phase.…”

The effects of combined high-frequency repetitive transcranial magnetic stimulation and cervical nerve root magnetic stimulation on upper extremity motor recovery following stroke

“…Another study (Hong et al, 2022) showed that HF-rTMS could inhibit M1 polarization of microglia after cerebral ischemia-reperfusion injury and alleviate ischemic stroke injury via regulating leT-7B-5P/HMGA2/NF-κB signaling pathway. A systematic review (Vabalaite et al, 2021) showed that HF-rTMS increased impaired upper limb motor function better than sham stimulation in stroke patients. Moslemi Haghighi et al (2021) also showed that HF-rTMS could effectively improve upper limb function for hemiplegia patients in the subacute stage of stroke.…”

Stroke Rehabilitation and Motor Recovery

“…No differences were found for the Fugl-Meyer Assessment or any secondary outcome between the repetitive transcranial magnetic stimulation and sham groups. Conversely, a 2021 systematic review concluded that high-frequency repetitive transcranial magnetic stimulation to the ipsilateral cortex results in decreased upper extremity impairment 108 . This technology has also been used in the treatment of aphasia 109 and other impairments 102 …”

“…Conversely, a 2021 systematic review concluded that high-frequency repetitive transcranial magnetic stimulation to the ipsilateral cortex results in decreased upper extremity impairment. 108 This technology has also been used in the treatment of aphasia 109 and other impairments. 102 Transcranial direct current stimulation delivers a small electrical current (1 mA to 2 mA) through the scalp and skull to the cortex, altering the excitability of brain tissue.…”