Comparative efficacy of different repetitive transcranial magnetic stimulation protocols for lower extremity motor function in stroke patients: a network meta-analysis

Chengshuo Wang; Qin Zhang; Linli Zhang; Dongyan Zhao; Yanan Xu; Zejian Liu; Chunli Wu; Shengzhu Wu; Mingjin Yong; Liang Wu

doi:10.3389/fnins.2024.1352212

Comparative efficacy of different repetitive transcranial magnetic stimulation protocols for lower extremity motor function in stroke patients: a network meta-analysis

Front Neurosci. 2024 Feb 15:18:1352212. doi: 10.3389/fnins.2024.1352212. eCollection 2024.

Authors

Chengshuo Wang^#^{1

2}, Qin Zhang^#², Linli Zhang¹, Dongyan Zhao², Yanan Xu², Zejian Liu², Chunli Wu¹, Shengzhu Wu³, Mingjin Yong⁴, Liang Wu²

Affiliations

¹ Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China.
² Beijing Xiaotangshan Hospital, Beijing, China.
³ Department of Rehabilitation Medicine, Neck-Shoulder and Lumbocrural Pain Hospital of Shandong First Medical University, Jinan, China.
⁴ Department of Rehabilitation, Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang, China.

^# Contributed equally.

Abstract

Background: Lower extremity motor dysfunction is one of the most severe consequences after stroke, restricting functional mobility and impairing daily activities. Growing evidence suggests that repetitive transcranial magnetic stimulation (rTMS) can improve stroke patients' lower extremity motor function. However, there is still controversy about the optimal rTMS protocol. Therefore, we compared and analyzed the effects of different rTMS protocols on lower extremity motor function in stroke patients using network meta-analysis (NMA).

Methods: We systematically searched CNKI, WanFang, VIP, CBM, PubMed, Embase, Web of Science, and Cochrane Library databases (from origin to 31 December 2023). Randomized controlled trials (RCTs) or crossover RCTs on rTMS improving lower extremity motor function in stroke patients were included. Two authors independently completed article screening, data extraction, and quality assessment. RevMan (version 5.4) and Stata (version 17.0) were used to analyze the data.

Results: A total of 38 studies with 2,022 patients were eligible for the NMA. The interventions included HFrTMS-M1, LFrTMS-M1, iTBS-Cerebellum, iTBS-M1, dTMS-M1, and Placebo. The results of NMA showed that LFrTMS-M1 ranked first in FMA-LE and speed, and HFrTMS-M1 ranked first in BBS, TUGT, and MEP amplitude. The subgroup analysis of FMA-LE showed that HFrTMS-M1 was the best stimulation protocol for post-stroke time > 1 month, and LFrTMS-M1 was the best stimulation protocol for post-stroke time ≤ 1 month.

Conclusion: Considering the impact of the stroke phase on the lower extremity motor function, the current research evidence shows that HFrTMS-M1 may be the preferred stimulation protocol to improve the lower extremity motor function of patients for post-stroke time > 1 month, and LFrTMS-M1 for post-stroke time ≤ 1 month. However, the above conclusion needs further analysis and validation by more high-quality RCTs.Systematic Review Registration:www.crd.york.ac.uk/prospero/, identifier (CRD42023474215).

Keywords: lower extremity; motor function; network meta-analysis; repetitive transcranial magnetic stimulation; stroke.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Beijing Municipal Administration of Hospitals Incubating Program (No.PX2024074) and the Capital Health Research and Development of Special (No.2020-2-2201).