Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Upper Limb Function After Stroke: A Systematic Review and Meta-Analysis

Functional recovery of motor deficits post-stroke is improved with physical therapy, however functional recovery is often incomplete. Non-invasive brain stimulation may enhance functional recovery post-stroke. This systematic review explored the effectiveness of high-frequency repetitive Transcranial Magnetic Stimulation (HF-rTMS) to improve upper limb motor function post-stroke. A database search was conducted within PubMed, CINAHL, Embase and Cochrane Library. Criteria for inclusion: randomised controlled trials employing HF-rTMS on the affected hemisphere of adults post-stroke, and using the Fugl-Meyer Assessment (FMA) tool. Sixteen articles were included in the review. There was significant improvement in FMA-UL scores immediately post-intervention (mean difference = 3.53 [95% CI 1.82 to 44.58]) and 1-3 months post-intervention (8.95 [5.95 to 11.95]) for patients who commenced treatment within 1-month of their stroke. Based on the FMA, excitatory rTMS may provide more favourable effects on motor recovery when applied in the first-month post-stroke, however a variety of heterogeneous application parameters limit the certainty of effectiveness.