Key Takeaways & Executive Findings
- •• Low-frequency repetitive transcranial magnetic stimulation significantly improves limb motor function in stroke patients, including hand function, overall motor function, activities of daily living, and balance. • The intervention did not show a significant effect on reducing upper limb muscle spasticity as measured by the modified Ashworth scale. • The meta-analysis included 8 high-quality randomized controlled trials with 502 patients, providing robust evidence for the efficacy of low-frequency repetitive transcranial magnetic stimulation in motor recovery. • Future research should focus on optimizing stimulation parameters, distinguishing stroke types, and conducting longer-term follow-up to confirm these findings.
Abstract
OBJECTIVE: Low-frequency repetitive transcranial magnetic stimulation significantly improves upper limb motor function in stroke patients, but its efficacy in reducing upper limb muscle spasticity remains controversial. Therefore, this study systematically evaluated the effects of low-frequency repetitive transcranial magnetic stimulation on limb motor function and upper limb muscle spasticity in stroke patients. METHODS: Utilizing computer search technology, this study meticulously screened randomized controlled studies targeting stroke patients undergoing low-frequency repetitive transcranial magnetic stimulation treatment from databases such as PubMed, EMBASE, ScienceDirect, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP, Wanfang, and China Biology Medicine disc. The experimental group received low-frequency repetitive transcranial magnetic stimulation alone or combined with physical therapy/conventional rehabilitation, while the control group received conventional rehabilitation, sham stimulation, or physical therapy. RevMan 5.3 software was used for meta-analysis. RESULTS: A total of 8 high-quality studies involving 502 patients were included. Meta-analysis showed that compared with the control group, the experimental group had significantly higher scores on the Brunnstrom hand motor function scale, Fugl-Meyer motor function scale, modified Barthel index, and Berg Balance Scale [MD=1.51, 95%CI(1.22, 1.80), P < 0.000 01; MD=5.69, 95%CI(3.18, 8.20), P < 0.000 01; MD=8.55, 95%CI(3.27, 13.84), P=0.002; MD=5.72, 95%CI(3.13, 8.32), P < 0.000 1], while there was no significant difference in the modified Ashworth score between the two groups [MD=-0.11, 95%CI(-0.17, 0.85), P=0.82]. CONCLUSION: Low-frequency repetitive transcranial magnetic stimulation can effectively improve limb motor function in stroke patients, especially hand motor function, overall limb motor function, activities of daily living, and balance ability, but it did not show a significant advantage in improving upper limb muscle spasticity. This conclusion still needs to be further verified by more studies with higher methodological quality, longer intervention duration, and follow-up.
1. Introduction
Stroke patients often experience upper limb motor dysfunction characterized by decreased muscle strength, abnormal increase in muscle tone, limited joint mobility, and altered corticospinal tract excitability, which significantly impacts their daily living independence and quality of life. In recent years, repetitive transcranial magnetic stimulation (rTMS) has gained attention as an innovative rehabilitation approach for post-stroke motor disorders. rTMS modulates cortical excitability to induce neuroplasticity, thereby promoting motor recovery. Specifically, low-frequency rTMS is believed to inhibit overactive cortical areas, facilitating functional reorganization of the damaged hemisphere. Multiple studies have confirmed that low-frequency rTMS can reduce the inhibitory effect of the contralesional hemisphere on the ipsilesional hemisphere, enhancing excitability of the affected hemisphere and improving upper limb motor function.
This study selected the Brunnstrom hand motor function stage, Fugl-Meyer upper extremity scale, modified Barthel index, and Berg Balance Scale as core outcome measures, all of which are recommended as Class I evidence by the AHA/ASA Stroke Rehabilitation Guidelines (2021 edition) and have good reliability and validity (intraclass correlation coefficient ≥0.92). The Brunnstrom hand motor function stage is specifically used to assess the recovery stage of fine hand movements, so it was listed separately to highlight upper limb function. Additionally, combining low-frequency rTMS with rehabilitation training has shown significant efficacy in clinical practice, leading to notable improvements in motor function scores. However, the effect of low-frequency rTMS on upper limb muscle spasticity remains controversial, with debates over its universal effectiveness across different severity levels, the optimal stimulation target (contralesional vs. ipsilesional hemisphere), and the most suitable timing and patient population. Therefore, this meta-analysis aims to comprehensively evaluate the effects of low-frequency rTMS on limb motor function and upper limb muscle spasticity in stroke patients.
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Ren Pengbo, Li Tingwen, Cai Feng, Zhang Jianhua (2026). Low-frequency repetitive transcranial magnetic stimulation improves limb motor function and upper limb muscles in stroke patients: a meta-analysis. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21681
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Frequently Asked Questions
What is low-frequency repetitive transcranial magnetic stimulation (rTMS)?
Low-frequency rTMS is a non-invasive brain stimulation technique that delivers repetitive magnetic pulses at a frequency of 1 Hz or lower to modulate cortical excitability. It is used in stroke rehabilitation to inhibit overactive brain regions and promote motor recovery.
Does low-frequency rTMS improve upper limb motor function in stroke patients?
Yes, according to this meta-analysis, low-frequency rTMS significantly improves upper limb motor function, including hand function, overall motor function, activities of daily living, and balance, as measured by various scales.
Does low-frequency rTMS reduce upper limb muscle spasticity after stroke?
The meta-analysis found no significant improvement in upper limb muscle spasticity as measured by the modified Ashworth scale, suggesting that low-frequency rTMS may not be effective for reducing spasticity.
What are the potential mechanisms of low-frequency rTMS in stroke recovery?
Low-frequency rTMS is thought to reduce the excessive excitability of the contralesional hemisphere, thereby decreasing transcallosal inhibition on the ipsilesional hemisphere. This enhances the excitability of the affected hemisphere and promotes neuroplasticity, facilitating motor recovery.
What are the limitations of this meta-analysis?
The meta-analysis included a limited number of studies (8) and patients (502). There was heterogeneity in stimulation parameters, stroke types, and intervention protocols. Additionally, the lack of significant effect on spasticity may be due to insufficient intervention duration or dosage. More high-quality studies with longer follow-up are needed.
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