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Repetitive transcranial magnetic stimulation as an alternative therapy for stroke with spasticity: a systematic review and meta-analysis

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Abstract

Repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) can be used to manage post-stroke spasticity, but a meta-analysis of the recent randomized-controlled trials (RCTs) is lacking. Our aim is to perform a meta-analysis of the RCTs that investigated the efficacy of rTMS in patients with post-stroke spasticity. PubMed, Embase, and Cochrane Library databases were searched for eligible papers published up to February 2020. The primary outcome was the Modified Ashworth Scale (MAS), measured as the effect of rTMS compared with controls and after rTMS (using a change score calculated separately in the active and sham treatment groups). Finally, five papers and eight data sets were included. rTMS had no significant benefit on MAS in patients with post-stroke spasticity compared to sham treatment (WMD = − 0.29, 95% CI − 0.58, 0.00; P = 0.051). When analyzing the change score in the treatment groups, a significant effect of rTMS was observed (WMD = − 0.27, 95% CI − 0.51, − 0.04; P = 0.024). When analyzing the change score in the sham treatment groups, no significant effect of sham treatment was observed, indicating no placebo effect (WMD = 0.32, 95% CI: − 0.40, 1.04; P = 0.387). We included the sample size, year of publication, percentage of male patients, and age difference in each study as covariates, and performed a meta-regression. The results showed no association between these variables and the MAS. Compared with sham stimulation, rTMS did not show a significant reduction in MAS for the patients who experienced post-stroke spasticity, but the patients reported a better outcome in MAS on a before-after scenario.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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  1. Peng Xu and Yan Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China

    Peng Xu, Yan Huang, Jie Wang, Xu An, Tianyou Zhang, Yuechun Li, Jun Zhang & Baojun Wang

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Jun Zhang and Peng Xu carried out the studies, participated in collecting data, and drafted the manuscript. Yan Huang and Baojun Wang performed the statistical analysis and participated in its design. Jie Wang and Xu An helped to draft the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jun Zhang or Baojun Wang.

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Ethical approval is not required for this study.

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415_2020_10058_MOESM1_ESM.tif

Supplementary Fig. S1. a. Sensitivity analysis of MAS for treatment vs. control; b. Sensitivity analysis of MAS before vs. after in the experimental group; c. Funnel plot of MAS before vs. after in the control group (TIF 376 kb)

Supplementary Table S1 (DOCX 19 kb)

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Xu, P., Huang, Y., Wang, J. et al. Repetitive transcranial magnetic stimulation as an alternative therapy for stroke with spasticity: a systematic review and meta-analysis. J Neurol 268, 4013–4022 (2021). https://doi.org/10.1007/s00415-020-10058-4

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