The effectiveness and safety of repetitive transcranial magnetic stimulation on spasticity after upper motor neuron injury: A systematic review and meta-analysis

Abstract

To systematically evaluate the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) on spasticity after upper motor neuron (UMN) injury. Eight electronic databases were searched from inception to August 6, 2022. Randomized controlled trials (RCTs) investigating the effectiveness and safety of rTMS on spasticity after UMN injury were retrieved. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Review Manager 5.3 and Stata 14.0 software were used to synthesize data. The certainty of the evidence was appraised with the Grade of Recommendation, Assessment, Development and Evaluation tool. Forty-two studies with a total of 2,108 patients were included. The results of meta-analysis revealed that, compared with control group, rTMS could significantly decrease scores of the Modified Ashworth Scale (MAS) in patients with UMN injury. The subgroup analysis discovered that rTMS effectively decreased the MAS scores in patients with stroke. Meanwhile, rTMS treatment > 10 sessions has better effect and rTMS could decrease the MAS scores of upper limb. Thirty-three patients complained of twitching facial muscles, headache and dizziness, etc. In summary, rTMS could be recommended as an effective and safe therapy to relieve spasticity in patients with UMN injury. However, due to high heterogeneity and limited RCTs, this conclusion should be treated with caution.

Effects of Maitland mobilization technique on upper extremity function in stroke survivors with spasticity: An experimental study

“…[ 4 ] At present, the clinical physical therapy of upper extremity spasticity in stroke includes acupuncture in traditional Chinese medicine, [ 5 ] neurodevelopmental therapies such as Bobath, Rood, and PNF techniques in physical medicine and rehabilitation field, such as extracorporeal shock wave, [ 6 ] neuromuscular electrical stimulation [ 7 ] and nerve regulation technology. [ 8 , 9 ] For patients with severe spasticity, muscle relaxants such as baclofen can also be taken orally, while clinicians should pay close attention to the dosage, timing and adverse reactions of drug intervention [ 10 ] ; at the same time, there are surgical approaches such as nerve block and transplantation. [ 10 , 11 ] Among them, neurodevelopmental therapy is the main physical therapy approach for spasticity intervention in rehabilitation medicine, [ 12 ] however, there is a problem of low treatment efficiency.…”

The clinical effects and multimodal-fMRI of paired associative stimulation on wrist flexor spasticity after stroke

“…Transcranial magnetic stimulation (TMS) is a new non-invasive neuromodulation technique, which has been widely used in neurological rehabilitation [5] . Many studies have con rmed that TMS can promote the recovery of motor function, but there is no consensus on the clinical effect of TMS on spasticity, and there…”

“…Inclusion criteria: (1) Patients aged 35-80 years old; (2) patients met the criteria for stroke diagnosis, the rst attack, right-handedness; (3) patients with wrist exor spasticity at level I-IV; (4) patients who have not received local injection therapy or orthosis wear in the past 1 months; (5) those with stroke onset within 3-18 months; (6) patients capable of understanding and performing movements following instructions; (7) those with stable vital signs; (8) patients who strictly followed the medication instructions by the doctor.…”