Repetitive transcranial magnetic stimulation for cognitive rehabilitation in stroke survivors: A systematic review and meta-analysis of randomized controlled trials.

Abstract

Cognitive impairments are one of the most common consequences in stroke survivors. Repetitive transcranial magnetic stimulation (rTMS) produces electromagnetic pulses transmitted through a coil over the individual's head. This review aims to examine the effects of rTMS on cognition in stroke survivors, identify who would be most likely to benefit from the therapy, define the optimal therapeutic parameters, and provide recommendations. "PubMed, Medline, Scopus, EMBASE, PEDro, and Web of Science" were searched until December 5, 2024. Comprehensive Meta-Analysis version 4 was used for quantitative analysis. The "Cochrane Collaboration tool" was employed to assess the quality of the selected studies. Thirteen studies met the eligibility criteria. In total, 608 stroke survivors (mean age 60.17 years) were involved in the present review. The meta-analysis showed a small, non-significant effect of rTMS on global cognitive function in stroke survivors (Functional independence measure-cognitive; SMD = 0.386, 95% CI: -0.331 to 1.103, p = .291), (Mini-Mental State Examination; SMD = 0.162, 95% CI: -0.405 to 0.730, p = .575), and (Montreal Cognitive Assessment; SMD = 0.204, 95% CI: -0.613 to 1.021, p = .625) with high heterogeneity (I² = 77-85%). While some studies reported improvements in specific cognitive domains, overall findings indicate substantial variability and uncertainty. This review highlights inconclusive evidence on the effects of rTMS on various cognitive domains in patients with stroke. The frequency of rTMS and coil location are essential factors in determining outcomes. Future studies are strongly warranted.