Unlocking Early Neural Plasticity: A Systematic Review and Meta-Analysis of Repetitive Transcranial Magnetic Stimulation on Motor Recovery in Acute Stroke.

Authors

Meixi Liu, Haozheng Li, Guohui Yang, Xiaoman Deng, Chong Guan, Xiuqin Lv, Shucong Peng, Junqiu Ma, Xiangtong Ji, Yi Wu, Lu Luo

Published in

Journal of integrative neuroscience. Volume 25. Issue 9. Pages 49076. Sep 21, 2026.

Abstract

Repetitive transcranial magnetic stimulation (rTMS) has demonstrated efficacy as a neuromodulatory technique in subacute and chronic stroke phases. However, evidence regarding its effectiveness in the acute phase remains limited, necessitating further synthesis and evaluation.
A comprehensive search was conducted across PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL (EBSCOhost) to November 1, 2025. The intervention in the experimental group must involve rTMS with or without any additional rehabilitation. Using a random-effects model, standardized mean differences (Hedges' g) were calculated for motor function (Fugl-Meyer Assessment, FMA), neurological deficits (National Institutes of Health Stroke Scale, NIHSS), independence (Barthel Index, BI), disability (Modified Rankin Scale, mRS), grip strength, and neurophysiological parameters (Motor Evoked Potential (MEP) amplitude, resting motor threshold (RMT), Central Motor Conduction Time (CMCT)). Heterogeneity was assessed using the I² statistic, and analyses were conducted with Stata.
A systematic literature search identified 17 studies meeting the inclusion criteria involving 846 acute ischemic stroke adults. rTMS significantly improved motor recovery (FMA: p < 0.01) and reduced neurological deficits (NIHSS: p < 0.01). It also enhanced independence (BI: p = 0.01) and reduced disability (mRS: p < 0.01; grip strength: p = 0.01). Neurophysiological outcomes indicated increased corticospinal excitability in the lesioned hemisphere (MEP amplitude: p < 0.01) and reduced RMT (p < 0.01), with no significant effect on CMCT. Subgroup analyses showed comparable benefits between ipsilesional high-frequency and contralesional low-frequency rTMS, though high-frequency protocols yielded significant improvements in activities of daily living (p = 0.01). Subthreshold stimulation and threshold stimulation were associated with NIHSS improvements (p < 0.01). Suprathreshold stimulation showed a non‑significant effect (p = 0.11).
Despite heterogeneity and limitations in evidence quality, rTMS shows promise as a neurorehabilitative intervention in acute stroke, potentially by modulating interhemispheric balance and promoting neuroplasticity.

PMID:
42811897
Bibliographic data and abstract were imported from PubMed on 30 Sep 2026.

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