Abstract
Acute
brain ischemia causes changes in several neural networks and related
cortico-subcortical excitability, both in the affected area and in the
apparently spared contralateral hemisphere. The modulation of these
processes through modern techniques of noninvasive brain stimulation,
namely repetitive transcranial magnetic stimulation (rTMS), has been
proposed as a viable intervention that could promote post-stroke
clinical recovery and functional independence. This review provides a
comprehensive summary of the current evidence from the literature on the
efficacy of rTMS applied to different clinical and rehabilitative
aspects of stroke patients. A total of 32 meta-analyses published until
July 2019 were selected, focusing on the effects on motor function,
manual dexterity, walking and balance, spasticity, dysphagia, aphasia,
unilateral neglect, depression, and cognitive function after a stroke.
Only conventional rTMS protocols were considered in this review, and
meta-analyses focusing on theta burst stimulation only were excluded.
Overall, both HF-rTMS and LF-rTMS have been shown to be safe and
well-tolerated. In addition, the current literature converges on the
positive effect of rTMS in the rehabilitation of all clinical
manifestations of stroke, except for spasticity and cognitive
impairment, where definitive evidence of efficacy cannot be drawn.
However, routine use of a specific paradigm of stimulation cannot be
recommended yet due to a significant level of heterogeneity of the
studies in terms of protocols to be set and outcome measures that have
to be used. Future studies need to preliminarily evaluate the most
promising protocols before going on to multicenter studies with large
cohorts of patients in order to achieve a definitive translation into
daily clinical practice.
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