Effects of Repetitive Transcranial Magnetic Stimulation on Upper Extremity Spasticity Post-Stroke: A Systematic Review

Abstract

Upper extremity spasticity is one of the most popular impairments following stroke. It can reduce patients' functional level. Recently, repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising tool in stroke rehabilitation. This review was conducted to investigate the immediate and long-term effects of rTMS on the upper extremity spasticity post-stroke and determine the optimal treatment protocols. PubMed, SCOPUS, PEDro, CINAHL, MEDLINE, REHABDATA, AMED, and Web of Science databases were searched for randomized controlled trials investigating the effect of rTMS on the upper extremity spasticity in patients with stroke. The methodological quality was assessed using the Cochrane Collaboration’s tool. Ten randomized clinical trials were met the inclusion criteria. A total of 225 patients were included in this analysis, 35.30% of whom were females. The mean age for all patients was 60.14 years. The findings showed heterogeneous evidence on the benefits of rTMS intervention in the upper extremity spasticity post-stroke. The evidence for the effect of rTMS on the upper extremity spasticity post-stroke is promising. Combining rTMS with other rehabilitation interventions may show a superior effect in reducing the upper extremity spasticity compared with rTMS intervention alone. Further randomized controlled trials with long-term follow-ups are warranted.

Zusammenfassung

Eine der häufigsten Langzeitfolgen nach einem Schlaganfall ist eine Spastik der oberen Extremitäten, die bei den betroffenen Patienten zu funktionellen Einschränkungen führen kann. In jüngster Zeit hat sich die repetitive transkranielle Magnetstimulation (rTMS) als vielversprechende Therapiemethode in der Rehabilitation nach einem Schlaganfall erwiesen.

In dieser Übersichtsarbeit wurden die unmittelbaren und langfristigen Effekte der rTMS auf die Spastizität der oberen Extremitäten nach einem Schlaganfall untersucht und die jeweils optimalen Behandlungsprotokolle ermittelt. Die Datenbanken PubMed, SCOPUS, PEDro, CINAHL, MEDLINE, REHABDATA, AMED und Web of Science wurden nach randomisierten, kontrollierten Studien durchsucht, in denen die Wirkung von rTMS auf die Spastizität der oberen Extremitäten bei Schlaganfallpatienten untersucht wurde. Die methodische Qualität wurde mit Hilfe des Tools der Cochrane Collaboration bewertet. Zehn randomisierte klinische Studien erfüllten die Einschlusskriterien. Insgesamt wurden 225 Patienten in die Analyse einbezogen, von denen 35,30% weiblich waren. Das Durchschnittsalter aller Patienten lag bei 60,14 Jahren.

Die Ergebnisse zeigten einheitlich den Nutzen einer rTMS-Intervention bei der Behandlung einer Spastik der oberen Extremitäten nach einem Schlaganfall. Die Evidenz für die Wirkung von rTMS auf die Spastik der oberen Extremitäten nach einem Schlaganfall ist vielversprechend.

Die Kombination von rTMS mit anderen Rehabilitationsmaßnahmen könnte eine deutlichere Verringerung der Spastik der oberen Extremitäten im Vergleich zur alleinigen rTMS-Behandlung bewirken. Weitere randomisierte kontrollierte Studien mit langfristigem Follow-up sind daher gerechtfertigt.

Key words

transcranial magnetic stimulation - upper limb - spasticity - stroke - rehabilitation

Schlüsselwörter

transkranielle Magnetstimulation - obere Extremität - Spastik - Schlaganfall - Rehabilitation - systematische Übersicht

Publication History

Received: 02 September 2021

Accepted: 09 November 2021

Article published online:
15 December 2021

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