Repetitive transcranial magnetic stimulation of primary motor cortex for stroke upper limb motor sequelae rehabilitation: A systematic review

Article type: Review Article

Authors: Sánchez-Cuesta, Francisco José^{a; b} | González-Zamorano, Yeray^{b; c} | Arroyo-Ferrer, Aída^{a; b} | Moreno-Verdú, Marcos^{a; b; *} | Romero-Muñoz, Juan Pablo^{a; b; d}

Affiliations: [a] Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain | [b] Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain | [c] Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, King Juan Carlos University, Alcorcón, Spain | [d] Brain Damage Unit, Beata María Ana Hospital, Madrid, Spain

Correspondence: [*] Address for correspondence: Dr. Marcos Moreno-Verdú, PT, PhD, GINDAT, Institute of Life Sciences, Francisco de Vitoria University, Carretera de Pozuelo un Majadahonda Km. 1800, 28223 Pozuelo de Alarcón, Spain. E-mail: marcos.moreno@ufv.es.

Abstract: BACKGROUND:Repetitive Transcranial Magnetic Stimulation (rTMS) over the primary motor cortex (M1) has been used to treat stroke motor sequelae regulating cortical excitability. Early interventions are widely recommended, but there is also evidence showing interventions in subacute or chronic phases are still useful. OBJECTIVE:To synthetize the evidence of rTMS protocols to improve upper limb motor function in people with subacute and/or chronic stroke. METHODS:Four databases were searched in July 2022. Clinical trials investigating the effectiveness of different rTMS protocols on upper limb motor function in subacute or chronic phases post-stroke were included. PRISMA guidelines and PEDro scale were used. RESULTS:Thirty-two studies representing 1137 participants were included. Positive effects of all types of rTMS protocols on upper limb motor function were found. These effects were heterogeneous and not always clinically relevant or related to neurophysiological changes but produced evident changes if evaluated with functional tests. CONCLUSION:rTMS interventions over M1 are effective for improving upper limb motor function in people with subacute and chronic stroke. When rTMS protocols were priming physical rehabilitation better effects were achieved. Studies considering minimal clinical differences and different dosing will help to generalize the use of these protocols in clinical practice.

Keywords: Repetitive transcranial magnetic stimulation, stroke, upper limb motor function, subacute, chronic, motor cortex

DOI: 10.3233/NRE-220306

Journal: NeuroRehabilitation, vol. 52, no. 3, pp. 329-348, 2023