Table 4.
Main clinical outcomes after transcranial magnetic stimulation.
| Model | Stroke stage | Technique | Types of protocol | Reported results | Clinical outcome | Signalling pathway | Data |
|---|---|---|---|---|---|---|---|
| Clinical data | Healthy volunteers | LF-rTMS | 1 Hz rTMS for 20–22 min at an intensity of 90% RMT (1 Hz rTMS: train of 10 pulses, 1 s wait time between trains, 120 trains, total pulses = 1200; 5 Hz rTMS: train of 25 pulses, 45 s wait time between trains, 24 trains, total pulses = 600); one volunteer additionally received 5 Hz rTMS in a separate session, 3 weeks after the 1 Hz protocol | Modulates neurotransmitter metabolism (increased GABA concentrations) | No significant changes for functional connectivity | No data | Gröhn et al., [143] |
| Acute and subacute | LF-rTMS | 20 minutes with 1 Hz rTMS, 5 days per week for a 2-week period | No side effects | Motor improvement and cognitive functions amelioration (unilateral spatial neglect and aphasia) | No data | Zheng et al., [152] Cha and Kim, [42] Weiduschat et al., [154] |
|
| For 20-30 min each time, 1 time/day, and 5 times/week, 4 weeks | Higher SOD levels, lower MDA and ET-1 | Improvement in cerebral oxygen metabolism and regulation of brain neurotransmitter | No data | Peng et al., [141] | |||
| c-TBS | In every session, 3-pulse bursts at 50 Hz repeated every 200 msec for 40 s were delivered at 80% of the active motor threshold over the left PPC (600 pulses). 15 every day 2 sessions of left PPC cTBS were applied with an interval of 15 minutes. Stimulation lasted for 10 days (5 days per week, Monday to Friday) and was applied daily at the same hour every morning (11 AM) to all patients | Possibly by counteracting the hyperexcitability of left hemisphere parieto-frontal circuits | Recovery from visual spatial neglect | No data | Koch et al., [155] | ||
| HF-rTMS | rTMS (daily at noon) consisted of ten 10-second trains of 3 Hz stimulation with 50 seconds between each train, for 10 days | No side effects | 10 consecutive days of rTMS employed as an add-on intervention to normal physical and drug therapies improved immediate clinical outcome in early stroke patients | No data | Khedr et al., [39] | ||
| rTMS applied for 10 min every day for 5 consecutive days, each session consisting of 10 trains of 3 Hz stimulation for 10 s and then repeated every minute | Increased excitability of the corticobulbar projections from both hemispheres with better projection from the stroke hemisphere | Motor improvement and recovery from dysphagia (maintained for 2 months) | No data | Khedr et al., [40] | |||
| A daily dose of 1000 pulses of subthreshold 10 Hz rTMS, 10 days | Higher movement accuracy; variable benefits in motor performance | Possible variable functional integrity of the corticospinal tract and different BDNF genotype | No data | Chang et al., [43]; Chang et al., [168] | |||
| iTBS and LF-rTMS | 7 days after stroke, for 10 days, iTBS (600 pulses) to the affected hemisphere; 1 Hz stimulation (1200 pulses) of the unaffected motor cortex hand area, also 10 days | No complications; motor improvement by iTBS; spasticity reduction by contralesional 1 Hz stimulation | Enhance motor recovery | No data | Watanabe et al., [41] | ||
| Chronic | LF-rTMS | 1 Hz, 25 minutes, a subthreshold rTMS over the unaffected hemisphere | Increase in the excitability of the affected motor cortex | rTMS improved the motor learning of the affected hand in patients after stroke; enhanced motor skill acquisition and training effect | No data | Takeuchi et al., [44] | |
| HF-rTMS | Pulses were applied twice daily at 3 Hz for 10 s with a 25-second interval, 20 times per session, alternating between left and right hemispheres (300 pulses for the left hemisphere and 300 pulses for the right hemisphere in one treatment session, 1,200 pulses per day) and were followed by 20 min of intensive swallowing rehabilitation exercise | No deterioration of neurological symptoms or adverse reactions such as convulsions or pneumonia | Improved laryngeal elevation delay time | No data | Momosaki et al., [159] | ||
| For the bilateral stimulation group, 500 pulses of 10 Hz rTMS over the ipsilesional and 500 pulses of 10 Hz rTMS over the contralesional motor cortices over the cortical areas that project to the mylohyoid muscles were administered daily, 2 consecutive weeks. For the unilateral stimulation group, 500 pulses of 10 Hz rTMS over the ipsilesional motor cortex over the cortical representation of the mylohyoid muscle and the same amount of sham rTMS over the contralesional hemisphere were applied | Magnetic stimulation over the cortical areas projecting to the mylohyoid muscles is effective as an additional treatment strategy to traditional dysphagia therapies | Swallowing parameters showed an improvement in the bilateral simulation group | No data | Park et al., [169] | |||
| LF-rTMS and HF-rTMS | 1 Hz rTMS over the unaffected hemisphere, 10 Hz rTMS over the affected hemisphere or bilateral rTMS comprising both the 1 Hz and 10 Hz rTMS | No side effects | An improvement in the motor function of the paretic hand | No data | Takeuchi et al., [156] | ||
| iTBS | Bursts of three pulses at 50 Hz given every 200 milliseconds in two-second trains, repeated every 10 seconds over 200 seconds for a total of 600 pulses | No side effects | Improvements in semantic fluency (language skills), stronger language lateralization to the dominant left hemisphere | No data | Szaflarski et al., [160] |
LF-rTMS: low-frequency repetitive transcranial magnetic stimulation; rTMS: repetitive transcranial magnetic stimulation; RMT: resting motor threshold; GABA: γ-aminobutyric acid; PPC: posterior parietal cortex; cTBS: continuous theta burst stimulation; BDNF: brain-derived neurotrophic factor; SOD: superoxide dismutase; MDA: malondialdehyde; ET-1: endothelin-1; iTBS: intermittent theta burst stimulation.