Table 1.
Summary of transcranial magnetic stimulation (TMS) in motor-function recovery.
| Author | Purpose | Number of Participants | Patient Type | Stimulation Mode | Stimulation Area | Intensity | Number of Pulses | Result |
|---|---|---|---|---|---|---|---|---|
| Juatmadja et al. 2020 [31] | To prove the effect of rTMS on extensor digitorum communis muscle strength improvement | 18 | Ischemic stroke | Affected contralesional, 10-Hz TMS | M1 | 100% RMT | 750 pulses per day | Significant increase of sEMG numbers in the extensor digitorum communis muscle strength. |
| Lüdemann-Podubecká et al. 2016 [34] | To examine the effects of rTMS on hand function and cortical neurophysiology | 10 | Subacute stroke with mild hand motor impairment | Unaffected contralesional, 1-Hz rTMS, control-rTMS |
PMd | 110% RMT | 900 pulses | Hand function tests revealed significant improvement of motor function of the affected, but not of the unaffected hand after actual rTMS only. Neither intervention changed the neurophysiological measures compared with those at baseline. |
| Long et al. 2018 [35] | To compare the effects of LF- and LF-HF rTMS on upper limb motor function | 62 | Upper limb hemiparesis in the early phase of stroke | Unaffected contralesional, 1-Hz rTMS, Unaffected contralesional 1-Hz rTMS + affected contralesional 10-Hz TMS, control rTMS |
M1 | 90% RMT | 1000 pulses | FMA scores and WMFT time over the baseline level were significantly increased in the LF-rTMS and LF-HF rTMS groups. |
| Matsuura et al. 2015 [33] | To investigate the effects of rTMS on functional recovery and electrophysiological measures | 20 | Acute stroke | Unaffected contralesional, 1-Hz rTMS, sham rTMS |
Motor cortex | 100% RMT | 1200 pulses | The FMA score in the real rTMS group was significantly improved compared with that in the sham group. The PPT score of only the affected limb was improved by rTMS. |
| Du et al. 2016 [39] | To compare the effects of HF-rTMS versus LF-rTMS on motor recovery and identify the neurophysiological correlation of motor improvements. | 69 | First-ever ischemic stroke with motor deficits | Unaffected contralesional, 1-Hz rTMS, affected contralesional, 3-Hz rTMS, sham rTMS |
M1 | 80%–90% RMT | 1200 pulses | The upper limb score of FMA in the 1-Hz group was significantly improved, but no difference was observed in the other groups. The lower limb score of FMA showed significant improvements in each real rTMS group compared with that in the sham group. The MRC score in both real rTMS groups was significantly improved compared with that in the sham group. |
| Nam et al. 2018 [36] | To investigate the long-term effect of rTMS on improvement of motor function | 76 | Subacute stroke | Affected contralesional, 10-Hz TMS, control rTMS |
M1 | 80% RMT | Repeated 20 times for a total of 1000 pulses | The motor strength, MFT, FAC classification and K-MBI scores did not differ between rTMS and control groups and rTMS did not have a long-term effect. |
| Hirakawa et al. 2018 [40] | To test the treatment effects of upper limb motor function | 26 | Chronic poststroke with severe upper limb | Unaffected contralesional, 1-Hz rTMS | Hand area of M1 | 90% RMT | One session consisted of 880 pulses | The FMA total score significantly increased from 12.6 to 18.0 points. The WMFT log performance time also significantly improved from 3.6 to 3.3. |
| Aşkın et al. 2017 [41] | To assess the efficacy of rTMS on upper extremity motor recovery and functional outcomes | 40 | Chronic ischemic stroke | Unaffected contralesional, 1-Hz rTMS, PT |
M1 | 90% RMT | 1200 pulses | FMA, BBT, motor and total FIM scores and FAS scores were significantly increased in both groups. |
| Goh et al. 2020 [42] | To investigate the effect of rTMS on improving dual-task gait performance | 15 | Left chronic stroke | Affected contralesional, 5-Hz rTMS | DLPFC, SMA, M1 |
90% RMT | 1200 pulses | Single-task gait speed remained unchanged after rTMS. rTMS applied to DLPFC appeared to result in a greater change in dual-task gait speed than that at the other two sites. |
| Wang et al. 2019 [43] | To investigate whether HF-rTMS enhances the effects of subsequent treadmill training | 14 | Poststroke time longer than 6 months | Affected contralesional, 5-Hz rTMS | The motor hot spot of the tibialis anterior | 90% RMT | 900 pulses | FMA scores, walking speed, spatial asymmetry, TA activity at follow-up and RF activity in the experimental group after training were improved and were significantly greater than those in the control–group. |
| Rastgoo et al. 2016 [44] | To investigate the effect of rTMS on lower extremity (LE) spasticity, motor function and motor neuronal excitability | 20 | Chronic stroke | Unaffected contralesional, 1-Hz rTMS, control rTMS | Lower extremity motor area | 90% RMT | 1000 pulses | LE-MMAS and LE-FMA scores were improved significantly only after active rTMS and this improvement was sustained 1 week after the intervention. |
| Bashir et al. 2016 [45] | To investigate the effect of rTMS on motor function and motor neuronal excitability | 16 | Chronic stroke patients and normal subjects | Unaffected contralesional, 1-Hz rTMS, right brain 1-Hz rTMS |
M1 | 90% RMT | 1200 pulses | Muscle strength, finger tapping speed and reaction–time performance increased for the hand ipsilateral to the stimulation, but not for the hand contralateral to the stimulated side. |
RMT—resting motor threshold; sEMG—surface electromyography; MFT—manual function test; FAC—functional ambulation classification; K-MBI—Korean version of the modified Barthel index; WMFT—wolf motor function test; PPT—Purdue pegboard test; BBT—box and block test; FIM—functional independence measurement; FAS—functional ambulation scale.