Effects of repetitive transcranial magnetic stimulation on walking and balance function after stroke: A systematic review and meta-analysis

Objective To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on walking and balance function in patients with stroke. Design MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, CENTRAL, and the Physiotherapy Evidence Database were comprehensively searched for randomized controlled trials published through March 2017 that investigated the effects of rTMS on lower limb function. Main outcomes included walking speed, balance function, motor function, and cortical excitability. Results Nine studies were included. The meta-analysis revealed a significant effect of rTMS on walking speed (SMD 0.64, 95% CI: 0.32 to 0.95), particularly ipsilesional stimulation (SMD 0.80, 95% CI: 0.36 to 1.24). No significant effects were found for balance function (SMD 0.10, 95% CI: -0.26 to 0.45), motor function (MD 0.50, 95% CI: -0.68 to 1.68) or cortical excitability (motor-evoked potentials (MEPs) of the affected hemisphere: MD 0.21 mV, 95% CI: -0.11 to 0.54; MEPs of the unaffected hemisphere: MD 0.09 mV, 95% CI: -0.16 to -0.02). Conclusion These results suggest that rTMS, particularly ipsilesional stimulation, significantly improves walking speed. Future studies with larger sample sizes and an adequate follow-up period are required to further understand the effects of rTMS on lower limb function and its relationship with changes in cortical excitability with the help of functional neuroimaging techniques. Corresponding Author: Dr. Chengqi He, No 37 Guo-xue-xiang Street, Chengdu, E-mail: hxkfhcq2015@126.com, Pro. Shasha Li, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA 02129, Email: pmr.shashali@gmail.com Author Disclosures: This work was supported by the National Natural Science Foundation of China, No. 81000852 and 81301677; the American Heart Association Award, No. 17POST32530004; the Supporting Project of Science & Technology of Sichuan Province of China, No. 2012SZ0140. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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