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Clinical application of repetitive transcranial magnetic stimulation in improving functional impairments post-stroke: review of the current evidence and potential challenges

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Abstract

In recent years, the stroke incidence has been increasing year by year, and the related sequelae after stroke, such as cognitive impairment, motor dysfunction, and post-stroke depression, seriously affect the patient’s rehabilitation and daily activities. Repetitive transcranial magnetic stimulation (rTMS), as a safe, non-invasive, and effective new rehabilitation method, has been widely recognized in clinical practice. This article reviews the application and research progress of rTMS in treating different functional impairments (cognitive impairment, motor dysfunction, unilateral spatial neglect, depression) after stroke in recent years, and preliminary summarized the possible mechanisms. It has been found that the key parameters that determine the effectiveness of rTMS in improving post-stroke functional impairments include pulse number, stimulated brain areas, stimulation intensity and frequency, as well as duration. Generally, high-frequency stimulation is used to excite the ipsilateral cerebral cortex, while low-frequency stimulation is used to inhibit the contralateral cerebral cortex, thus achieving a balance of excitability between the two hemispheres. However, the specific mechanisms and the optimal stimulation mode for different functional impairments have not yet reached a consistent conclusion, and more research is needed to explore and clarify the best way to use rTMS. Furthermore, we will identify the issues and challenges in the current research, explore possible mechanisms to deepen understanding of rTMS, propose future research directions, and offer insightful insights for better clinical applications.

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Acknowledgements

This work was supported by the grant of the funding of the Youth Fund Project of Research Planning Foundation on Humanities and Social Sciences of the Ministry of Education (20YJCZH001), the horizontal research project (HXXM-22-03-005), and the Shanghai Sailing Program (22YF1441600).

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  1. Ming Cai, Jia-ling Zhang and Xiao-jun Wang contributed equally to this work.

Authors and Affiliations

  1. College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China

    Ming Cai, Jia-ling Zhang, Ke-ren Cai, Shu-yao Li, Xin-lin Du, Li-yan Wang, Ruo-yu Yang, Jia Han & Jie Lyu

  2. Medical Research and Education Department, Shanghai Health Rehabilitation Hospital, Shanghai, 201615, China

    Xiao-jun Wang

  3. Central Lab, Shanghai Key Laboratory of Pathogenic Fungi Medical Testing, Shanghai Pudong New Area People’s Hospital, Shanghai, 201299, China

    Jing-yun Hu

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Ming CAI, Jingyun HU, and Jie LYU designed and conceived the article. Jialing ZHANG and Xiaojun WANG wrote the article. Keren CAI, Shuyao LI, Xinlin DU, and Liyan WANG collected information and made analysis. Ruoyu YANG and Jia HAN revised the article. All authors read and approved the final version of the paper.

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Cai, M., Zhang, Jl., Wang, Xj. et al. Clinical application of repetitive transcranial magnetic stimulation in improving functional impairments post-stroke: review of the current evidence and potential challenges. Neurol Sci 45, 1419–1428 (2024). https://doi.org/10.1007/s10072-023-07217-6

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