EFFICACY OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION FOR IMPROVING LOWER LIMB FUNCTION IN INDIVIDUALS WITH NEUROLOGICAL DISORDERS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED SHAM-CONTROLLED TRIALS

Journal of Rehabilitation Medicine, 2022 · DOI: 10.2340/jrm.v53.1097 · Published: December 15, 2022

Neurology Neurological Disorders Rehabilitation

Simple Explanation

Non-invasive magnetic brain stimulation can cause beneficial changes in the central nervous system of individuals with neurological disorders, which, in turn, may have a number of therapeutic qualities. Combined data from these studies suggested that real stimulation, compared with placebo, had positive effects specifically for recovery of walking ability and maximal leg muscle strength, as well as for improvement in overall leg movement function in individuals with stroke, Parkinson’s disease and spinal cord injury. These findings are important for patients and therapists seeking to improve rehabilitation outcomes. This research area deserves increased scientific focus.

Study Duration

Not specified

Participants

Individuals with neurological disorders (n=27 studies)

Evidence Level

Systematic Review and Meta-Analysis of Randomized Sham-Controlled Trials

Key Findings

1
An overall effect of repetitive transcranial magnetic stimulation was found for outcomes: gait (effect size [95% confidence interval; 95% CI]: 0.51 [0.29; 0.74], p = 0.003) and muscle strength (0.99 [0.40; 1.58], p = 0.001) and disorders: stroke (0.20 [0.00; 0.39], p = 0.05), Parkinson’s disease (1.01 [0.65; 1.37], p = 0.02) and spinal cord injury (0.50 [0.14; 0.85], p = 0.006), compared with sham.
2
No effect was found for outcomes: mobility and balance.
3
A large and homogenous effect of real rTMS on the SCI-specific variant of the Medical Research Council (MRC) scale for lower limb muscle strength (LEMS, Lower Extremity Motor Score) was found ((ES: 0.99 [0.40; 1.58], p = 0.001, I2 = 9%).

Research Summary

This study reviewed 27 RCTs examining the effects of rTMS vs sham stimulation on lower limb functional outcome measures in individuals with neurological disorders. A statistically significant effect of real rTMS compared with sham stimulation was found for outcome parameters: gait and muscle strength and for disorder types: stroke, PD and SCI. In conclusion, the findings of the current study suggest that implementing rTMS as an adjunct therapy to neurorehabilitation may be a viable strategy to promote ambulation and lower limb muscle strength.

Practical Implications

Enhance Rehabilitation Strategies

rTMS may be a viable strategy to promote ambulation and lower limb muscle strength in neurorehabilitation.

Targeted Application

rTMS appears to enhance recovery of overall lower limb motor function specifically for individuals with stroke, Parkinson’s disease, and spinal cord injury.

Personalized Treatment Protocols

Further investigations of the inter-individual variability in response to rTMS treatment are needed to optimize the rehabilitation of neurological patients.

Study Limitations

1
The included studies were heterogeneous, had small to medium sample sizes and presented a moderate risk of selection, attrition and reporting bias.
2
A considerable risk of bias due to non-reporting was present in all categories except for disorder: SCI.
3
Treatment effects varied between the included studies and the results are synthesized from heterogeneous studies, which employed moderate sample sizes and presented with risk of bias.

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