Clinical Effects of Repetitive Transcranial Magnetic Stimulation on Lower Limb Motor Function, Balance and Gait in Chronic Stroke: A Randomized, sham-controlled Trial.

Abstract

We aimed to evaluate the effectiveness of combining Low-Frequency (1 Hz) rTMS (LF-rTMS) over the unaffected hemisphere or Intermittent Theta Burst Stimulation (iTBS) over the affected hemisphere with conventional rehabilitation (CR) on lower extremity motor function, balance and gait. This single-center, randomized, sham-controlled study included patients with chronic stroke (>6 mo) and unilateral hemiplegia (Brunnstrom stages 3-5), who were assigned to LF-rTMS+CR (n=21), iTBS+CR (n=21), or sham rTMS+CR (n=21) for 10 sessions using a figure-of-eight coil. All active participants completed treatment, and 18 sham participants were analyzed. The Fugl-Meyer Assessment, Berg Balance Scale (BBS), Timed-Up and Go (TUG) test, Functional Independence Measure, and 36-item Short Form Health Survey (SF-36) were performed during pretreatment, posttreatment, and 6-week follow-up, alongside assessments of the Hmax/Mmax amplitude at baseline and 6-week follow-up. Both real rTMS groups showed greater improvements in balance and mobility (BBS and TUG) versus sham group. Additionally, intragroup evaluation revealed that improvements in mental function and general health (SF-36) were more pronounced in the real rTMS groups. The combination of rTMS, including LF-rTMS or iTBS, with CR may serve as an effective neurorehabilitation strategy to improve balance and mobility in individuals with chronic stroke.