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      Effects of transcranial magnetic stimulation in modulating cortical excitability in patients with stroke: a systematic review and meta-analysis

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          Abstract

          Background

          Transcranial magnetic stimulation (TMS) has attracted plenty of attention as it has been proved to be effective in facilitating motor recovery in patients with stroke. The aim of this study was to systematically review the effects of repetitive TMS (rTMS) and theta burst stimulation (TBS) protocols in modulating cortical excitability after stroke.

          Methods

          A literature search was carried out using PubMed, Medline, EMBASE, CINAHL, and PEDro, to identify studies that investigated the effects of four rTMS protocols—low and high frequency rTMS, intermittent and continuous TBS, on TMS measures of cortical excitability in stroke. A random-effects model was used for all meta-analyses.

          Results

          Sixty-one studies were included in the current review. Low frequency rTMS was effective in decreasing individuals’ resting motor threshold and increasing the motor-evoked potential of the non-stimulated M1 (affected M1), while opposite effects occurred in the stimulated M1 (unaffected M1). High frequency rTMS enhanced the cortical excitability of the affected M1 alone. Intermittent TBS also showed superior effects in rebalancing bilateral excitability through increasing and decreasing excitability within the affected and unaffected M1, respectively. Due to the limited number of studies found, the effects of continuous TBS remained inconclusive. Motor impairment was significantly correlated with various forms of TMS measures.

          Conclusions

          Except for continuous TBS, it is evident that these protocols are effective in modulating cortical excitability in stroke. Current evidence does support the effects of inhibitory stimulation in enhancing the cortical excitability of the affected M1.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12984-022-00999-4.

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          Most cited references90

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

          David Moher, Alessandro Liberati, Jennifer Tetzlaff … (2009)
          Article 0 comments Cited 7205 times – based on 0 reviews     Review now
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            A basic introduction to fixed-effect and random-effects models for meta-analysis.

            Michael R. Borenstein, Larry Hedges, Julian P.T. Higgins … (2010)
            There are two popular statistical models for meta-analysis, the fixed-effect model and the random-effects model. The fact that these two models employ similar sets of formulas to compute statistics, and sometimes yield similar estimates for the various parameters, may lead people to believe that the models are interchangeable. In fact, though, the models represent fundamentally different assumptions about the data. The selection of the appropriate model is important to ensure that the various statistics are estimated correctly. Additionally, and more fundamentally, the model serves to place the analysis in context. It provides a framework for the goals of the analysis as well as for the interpretation of the statistics. In this paper we explain the key assumptions of each model, and then outline the differences between the models. We conclude with a discussion of factors to consider when choosing between the two models. Copyright © 2010 John Wiley & Sons, Ltd. Copyright © 2010 John Wiley & Sons, Ltd.
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              Theta burst stimulation of the human motor cortex.

              Ying-Zu Huang, Mark J Edwards, Elisabeth Rounis … (2005)
              It has been 30 years since the discovery that repeated electrical stimulation of neural pathways can lead to long-term potentiation in hippocampal slices. With its relevance to processes such as learning and memory, the technique has produced a vast literature on mechanisms of synaptic plasticity in animal models. To date, the most promising method for transferring these methods to humans is repetitive transcranial magnetic stimulation (rTMS), a noninvasive method of stimulating neural pathways in the brain of conscious subjects through the intact scalp. However, effects on synaptic plasticity reported are often weak, highly variable between individuals, and rarely last longer than 30 min. Here we describe a very rapid method of conditioning the human motor cortex using rTMS that produces a controllable, consistent, long-lasting, and powerful effect on motor cortex physiology and behavior after an application period of only 20-190 s.
              Article 0 comments Cited 595 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Zhongfei Bai: zhong-fei.bai@connect.polyu.hk
                Jiaqi Zhang: jack-jq.zhang@connect.polyu.hk
                Kenneth N. K. Fong:
                ORCID: http://orcid.org/0000-0001-5909-4847
                rsnkfong@polyu.edu.hk
                Journal
                Journal ID (nlm-ta): J Neuroeng Rehabil
                Journal ID (iso-abbrev): J Neuroeng Rehabil
                Title: Journal of NeuroEngineering and Rehabilitation
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1743-0003
                Publication date (Electronic): 22 February 2022
                Publication date PMC-release: 22 February 2022
                Publication date Collection: 2022
                Volume: 19
                Electronic Location Identifier: 24
                Affiliations
                [1 ]GRID grid.16890.36, ISNI 0000 0004 1764 6123, Department of Rehabilitation Sciences, , The Hong Kong Polytechnic University, ; Kowloon, Hong Kong SAR China
                [2 ]GRID grid.511949.1, ISNI 0000 0004 4902 0299, Department of Occupational Therapy, , Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), ; Shanghai, China
                [3 ]GRID grid.24516.34, ISNI 0000000123704535, Department of Rehabilitation Sciences, , Tongji University School of Medicine, ; Shanghai, China
                Author information
                http://orcid.org/0000-0001-5909-4847
                Article
                Publisher ID: 999
                DOI: 10.1186/s12984-022-00999-4
                PMC ID: 8862292
                PubMed ID: 35193624
                SO-VID: edcbd139-2ea9-49ee-9d5e-99e33d75f9aa
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 10 August 2021
                Date accepted : 28 January 2022
                Funding
                Funded by: General Research Fund, Research Grants Council, University Grants Committee, Hong Kong
                Award ID: 151059/19M
                Award Recipient :
                Funded by: Shanghai Sailing Program, Shanghai, China
                Award ID: 20YF1445100
                Award Recipient :
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Neurosciences
                Keywords: stroke,transcranial magnetic stimulation,cortical excitability,motor-evoked potentials,interhemispheric imbalance
                Data availability:
                ScienceOpen disciplines: Neurosciences
                Keywords: stroke, transcranial magnetic stimulation, cortical excitability, motor-evoked potentials, interhemispheric imbalance

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