Article

Repetitive Transcranial Magnetic Stimulation (rTMS) is known to modulate cortical
excitability and has thus been suggested to be a therapeutic approach for
improving the efficacy of rehabilitation for motor recovery after stroke. In
addition to producing effects on cortical excitability, stroke may affect the
balance of transcallosal inhibitory pathways between motor primary areas in both
hemispheres: the affected hemisphere (AH) may be disrupted not only by the
infarct itself but also by the resulting asymmetric inhibition from the
unaffected hemisphere, further reducing the excitability of the AH. Conceptually,
therefore, rTMS could be used therapeutically to restore the balance of
interhemispheric inhibition after stroke. rTMS has been used in two ways:
low-frequency stimulation (</=1 Hz) to the motor cortex of the unaffected
hemisphere to reduce the excitability of the contralesional hemisphere or
high-frequency stimulation (>1 Hz) to the motor cortex of the AH to increase
excitability of the ipsilesional hemisphere. The purpose of this systematic
review is to collate evidence regarding the safety and efficacy of high-frequency
rTMS to the motor cortex of the AH. The studies included investigated the
concurrent effects of rTMS on the excitability of corticospinal pathways and
upper-limb motor function in adults after stroke. This review suggests that rTMS
applied to the AH is a safe technique and could be considered an effective
approach for modulating brain function and contributing to motor recovery after
stroke. Although the studies included in this review provide important
information, double-blinded, sham-controlled Phase II and Phase III clinical
trials with larger sample sizes are needed to validate this novel therapeutic
approach.

Langue : ANGLAIS