Woo-Jin Kim, Charlotte Rosselin, Bhasker Amatya, Pouya Hafezi, Fary Khan
Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, University of Inje College of Medicine, Busan, Korea
DOI: 10.2340/16501977-2637

Objective: To evaluate evidence from published systematic reviews of clinical trials to determine the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in stroke population.
Methods: The Cochrane Library, MEDLINE, CINAHL, EMBASE, and PubMed were searched for systematic reviews up to 15 January 2019. Three authors independently screened the reviews and assessed the methodological quality, using Assessment of Multiple Systematic Reviews (AMSTAR) appraisal tool. Quality of evidence for outcomes evaluated within the reviews was appraised with Grade of Recommendation, Assessment, Development and Evaluation (GRADE) tool.
Results: Twelve reviews (n = 9,117 participants) evaluated the effectiveness of rTMS on motor and non-motor (aphasia, depression, dysphagia and cognition) functions. The rTMS protocols applied and outcomes measured were diverse amongst the selected reviews. The findings suggest beneficial effect of rTMS with: “moderate quality” evidence for dysphagia and hemineglect, “low to moderate quality” evidence for motor function (upper limb function, daily activities), and “low quality” evidence for aphasia and post-stroke depression.
Conclusion: Despite widespread use of rTMS, high-quality evidence for its routine use for the treatment of stroke survivors is lacking. Further studies are required to establish differential roles of various protocols and long-term effects of rTMS in the stroke population.

Stroke causes significant disability and morbidity. Currently, a range of rehabilitation interventions to manipulate or induce brain plasticity, including repetitive trans-cranial magnetic stimulation (rTMS) are used for stroke care. There is a growing body of research in this area, with several systematic reviews evaluating efficacy and safety of rTMS for various clinical outcomes. This review systematically evaluates evidence from published systematic reviews of clinical trials to determine the effectiveness of rTMS in people with stroke to guide treating clinicians. The included reviews used varied rTMS protocols and outcome measures. The findings suggest limited high-quality evidence for improved motor and non-motor functions following stroke; hence, routine clinical use of rTMS is yet to be established.

Appendix S1
Appendix S2