Clinical applications of rTMS in motor rehabilitation after stroke

Abstract

Both inhibitory and excitatory ipsilesional and contralesional non-invasive brain stimulation protocols (rTMS, TBS) have been applied during the acute, postacute and chronic phases to improve motor recovery in stroke patients having upper and/or lower limb paresis. A best evidence synthesis based on RCTs and meta-analyses is presented that can be used for clinical decision making. Taken together, there is a substantial database indicating that the above-mentioned rTMS applications are safe when the conventional safety recommendations are followed. The intervention that had best been investigated is contralesional M1 low-frequency (inhibitory) rTMS. The most focused meta-analysis reported to date documents an overall effect size of 0.55 on average for rTMS therapies in arm motor rehabilitation after stroke that can be considered moderate. Given the low risk profile and the demonstrated clinical benefits, there is reason to recommend and apply rTMS therapy in stroke patients with motor deficits, especially arm paresis.