The Effect of Intermittent Theta Burst Stimulation for Post-Stroke Lower Limb Motor Recovery: Systematic Review and Meta-Analysis

Background Intermittent theta burst stimulation (iTBS) appears to be a potential intervention for enhancing motor recovery in post-stroke. However, the optimal parameters of iTBS protocol for lower limb dysfunction is ambiguous. Objective To evaluate the efficacy of iTBS in treating lower limb motor impairment after stroke and to explore the optimal stimulation parameters. Methods Relevant randomized controlled trials (RCTs) were retrieved from seven databases from their inception to May 2024. We defined primary outcomes as Fugl-Meyer Assessment for Lower Extremity (FMA-LE) and Berg Balance Scale (BBS). Subgroup analyses included stroke stage, stimulation sites, dosages and treatment sessions. Results The study results indicated that compared with the sham iTBS group, the iTBS group showed a significant improvement in lower limb motor recovery, balance, gait and activity of daily living (ADL). No significant effect was found in the Motor Evoked Potential amplitude. Subgroup analysis demonstrated that cerebellar iTBS had a therapeutic effect on subacute stroke patients. Furthermore, administrating 1200 pulses per session for a minimum of 15 sessions of iTBS intervention could significantly improve the balance and ADL performance. Conclusion iTBS could enhance lower limb motor function, improving the quality of life in subacute stroke patients with relatively high safety. Systematic review registration: CRD42024549603