Effect of repetitive transcranial magnetic stimulation on balance function in patients with stroke: A systematic review

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is a noninvasive and painless technique used to modulate central nervous system activity. It has shown promise in improving motor, swallowing, speech, and cognitive functions in patients after stroke. However, limited research has focused on its effect on post-stroke balance, and stimulation parameters remain inconsistent.ObjectiveTo systematically evaluate the efficacy of rTMS on balance function in stroke patients by analyzing stimulation parameters, target sites, and clinical outcomes from recent RCTs, and to identify optimal evidence-based protocols for post-stroke balance rehabilitation.MethodsThe PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched for RCTs. Eighteen RCTs were included. All included studies demonstrated high methodological quality (PEDro scores ≥ 6).ResultsThe primary motor cortex (M1) and cerebellum were the most frequently targeted stimulation sites. Most studies employed low-frequency rTMS (LF-rTMS) or iTBS. Across the included studies, rTMS demonstrated improvements in balance(BBS), lower-limb motor function(FMA-LE) and gait parameters compared with control groups (P < 0.05). Effect sizes varied depending on stimulation site and parameters. Clinical improvements were sustained across multiple assessment domains. Some studies reported a greater reduction in pdBSI in the rTMS group (mean difference: -0.12, 95% CI:-0.22 to -0.02, P = 0.026) and a smaller increase in MEP amplitude (mean difference: 8.5 μV, 95% CI:0.9 to 16.1 μV, P = 0.028).ConclusionCurrent evidence suggests that rTMS targeting M1 or cerebellum may effectively improve balance in stroke patients. Preliminary evidence supports either (1) LF-rTMS to the unaffected M1 or (2) cerebellar iTBS as potentially effective protocols. However, further high-quality trials are needed to establish standardized treatment parameters.