Repetitive Transcranial Magnetic Stimulation On Motor Recovery For Patients With Stroke:A Prisma Compliant Systematic Review And Meta-Analysis

Objective:A systematic review and meta-analysis was conducted to determine the effectiveness of repetitive transcranial magnetic stimulation（rTMS）on the recovery of motor function in patients with stroke.To prove the efficacy and safety of repetitive transcranial magnetic stimulation treatment about limb dysfunction after stroke and provide some reference basis for future clinical treatment and new ideas.Subjects and Methods:A comprehensive literature search was performed to identify studies published before September 20^th,2018.Electronic databases include PubMed,Embase,Web of Science and Cochrane Central Register of Controlled Trials were searched to identify the relevant literature.Standard mean differences（SMD）and 95%confidence intervals（CI）were used to evaluate the effects of rTMS.Publishing status is unlimited（journals,academic papers,conference documents and other gray literature）,and the language is English.The outcome indicators of the study must include at least one of the following:Fugl-Meyer Assessment（FMA）,grip strength,Jebsen-Taylor hand function test（JTHF）,Barthel Index（BI）,and National Institutes of Health Stroke Scale（NIHSS）.Standard mean difference（SMD）and 95%confidence interval（CI）were used to evaluate the effect of rTMS.The stability,sensitivity and heterogeneity of the results were analyzed using the Stata14.1 software,and the quality of the study was evaluated using the Cochrane risk of bias tool.Results:In total,20 randomized controlled trials（RCTs）（n=841patients）were included.The results showed that rTMS is beneficial to patients with post-stroke hemiplegia,as demonstrated by four scales:Fugl-Meyer Assessment（SMD=0.645,95%CI:0.493–0.789）;grip strength（SMD=1.15;95%CI:0.761–1.534）;Barthel Index（SMD=0.580;95%CI:0.377–0.783）;and National Institutes of Health Stroke Scale（SMD=-0.555;95%CI:-0.813–-0.298）.Few adverse events were observed.Conclusion:The analysis showed that rTMS has a positive effect on motor function recovery in the upper and lower limbs of patients with post-stroke hemiplegia,regardless of the frequency used.