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Article summary:
1. This systematic review and meta-analysis investigated the effects of four forms of transcranial magnetic stimulation (TMS) protocols—low and high frequency rTMS, intermittent and continuous TBS—on modulating cortical excitability in stroke patients.
2. Low frequency rTMS was effective in decreasing individuals’ resting motor threshold and increasing the motor-evoked potential of the non-stimulated M1 (affected M1), while opposite effects occurred in the stimulated M1 (unaffected M1).
3. Intermittent TBS showed superior effects in rebalancing bilateral excitability through increasing and decreasing excitability within the affected and unaffected M1, respectively.
Article analysis:
The article “Effects of transcranial magnetic stimulation in modulating cortical excitability in patients with stroke: a systematic review and meta-analysis” is a well-structured, comprehensive review that provides an overview of the current evidence on the use of transcranial magnetic stimulation (TMS) for modulating cortical excitability in stroke patients. The authors conducted a thorough literature search to identify relevant studies, which were then evaluated for quality using established criteria. The results were presented clearly and concisely, with appropriate statistical analyses used to assess the pooled effect sizes.
The article is generally reliable and trustworthy; however, there are some potential biases that should be noted. Firstly, most of the included studies had small sample sizes, which may have limited their power to detect significant differences between groups or to detect subtle changes over time. Secondly, most studies only included participants with chronic stroke (>6 months post-stroke), so it is unclear whether these findings can be generalized to those with acute stroke (<6 months post-stroke). Thirdly, due to the limited number of studies found, the effects of continuous TBS remained inconclusive; thus further research is needed to confirm its efficacy. Finally, although correlations between TMS measures and motor impairment were reported, it is unclear whether these changes are clinically meaningful or not.
In conclusion, this article provides a comprehensive overview of current evidence on TMS for modulating cortical excitability in stroke patients; however, further research is needed to confirm its efficacy in acute stroke patients as well as its clinical relevance.