Clinical Effects of Repetitive Transcranial Magnetic Stimulation on Lower Limb Motor Function, Balance and Gait in Chronic Stroke

OBJECTIVE: We aimed to evaluate the effectiveness of combining low-frequency (1 Hz) rTMS (LF-rTMS) over the unaffected hemisphere or intermittent theta burst stimulation (iTBS) over the affected hemisphere with conventional rehabilitation (CR) on lower extremity motor function, balance, and gait. DESIGN: This single-center, randomized, sham-controlled study included patients with chronic stroke (>6 mo) and unilateral hemiplegia (Brunnstrom stages 3 to 5), who were assigned to LF-rTMS+CR (n=21), iTBS+CR (n=21), or sham rTMS+CR (n=21) for 10 sessions using a figure-of-eight coil. All active participants completed treatment, and 18 sham participants were analyzed. The Fugl-Meyer Assessment, Berg Balance Scale (BBS), Timed-Up and Go (TUG) test, Functional Independence Measure, and 36-item Short-Form Health Survey (SF-36) were performed during pretreatment, post-treatment, and 6-week follow-up, alongside assessments of the Hmax/Mmax amplitude at baseline and 6-week follow-up. RESULTS: Both real rTMS groups showed greater improvements in balance and mobility (BBS and TUG) versus sham group. In addition, intragroup evaluation revealed that improvements in mental function and general health (SF-36) were more pronounced in the real rTMS groups. CONCLUSIONS: The combination of rTMS, including LF-rTMS or iTBS, with CR may serve as an effective neurorehabilitation strategy to improve balance and mobility in individuals with chronic stroke.