| 摘要 |
[Objectives] To evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on neurophysiological outcomes in patients with acute stroke. [Methods] A systematic literature search was conducted across PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases up to March 1, 2025. Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) involving adult patients (≥18 years) with acute ischemic stroke (within 2 weeks of onset) who received rTMS intervention were included. Data on motor evoked potential (MEP) amplitude, resting motor threshold (RMT), and central motor conduction time (CMCT) were extracted. The quality of the studies was assessed using the Cochrane risk of bias tool. Statistical analyses were performed using Stata 18.0, with standardized mean differences (SMDs) and 95% confidence intervals (CIs) calculated. Heterogeneity was evaluated using the I2 statistic. [Results] Eight studies involving 932 identified records met the inclusion criteria. Meta-analysis revealed that rTMS significantly increased MEP amplitude (Hedges’ g=0.77, 95% CI: 0.52-1.02, P<0.01) and reduced RMT (Hedges’ g=-1.13, 95% CI: -1.63 to -0.62, P<0.01) in the lesioned hemisphere, indicating enhanced corticospinal excitability. No significant effects were observed on MEP amplitude or RMT in the unaffected hemisphere. Additionally, rTMS did not significantly alter CMCT in either hemisphere. Heterogeneity was low to moderate for most outcomes, and no significant publication bias was detected. [Conclusions] rTMS is a safe and effective intervention for improving corticospinal excitability and motor recovery in patients with acute stroke. Both high-frequency stimulation of the ipsilesional hemisphere and low-frequency stimulation of the contralesional hemisphere have demonstrated beneficial effects, supporting the interhemispheric inhibition model. Future large-scale, multi-center RCTs are needed to optimize rTMS parameters and establish standardized treatment protocols for acute stroke rehabilitation. |
