Meta-analysis suggests specific rTMS protocols improve cognitive and functional outcomes in stroke survivors

This Bayesian network meta-analysis examined repetitive transcranial magnetic stimulation (rTMS) protocols with different frequencies and sites in 2543 patients with post-stroke cognitive impairment. The analysis compared various rTMS protocols to assess their impact on cognitive and functional outcomes. Primary outcomes included the Montreal Cognitive Assessment, Mini-Mental State Examination, and Modified Barthel Index. The study synthesized evidence from existing literature to rank the efficacy of different stimulation strategies.

The results indicated that high-frequency left dorsolateral prefrontal cortex stimulation most effectively improved Montreal Cognitive Assessment scores with a mean difference of 3.38 and a SUCRA of 87.6 percent. High-frequency right-sided stimulation ranked highest for Mini-Mental State Examination improvement with a mean difference of 2.93 and a SUCRA of 79.7 percent. High-frequency bilateral stimulation yielded the greatest enhancement for the Modified Barthel Index with a mean difference of 13.47 and a SUCRA of 89.6 percent.

The authors recommend high-frequency left dorsolateral prefrontal cortex, high-frequency right-sided, and high-frequency bilateral stimulation as optimal interventions for Montreal Cognitive Assessment, Mini-Mental State Examination, and Modified Barthel Index outcomes, respectively. However, the study highlights that further studies are warranted to validate stimulation parameters and expand multicenter evidence for clinical application. Safety data regarding adverse events, serious adverse events, discontinuations, and tolerability were not reported in the source material.