Acupuncture combined with repetitive transcranial magnetic stimulation for enhancing cortical excitability in the lesional hemisphere after ischemic stroke: A systematic review and meta-analysis

IF 2.1 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-12-01 Epub Date: 2025-10-27 DOI:10.1016/j.jstrokecerebrovasdis.2025.108477

Baoyi Li MM , Qin Wang MD , Haibo Su MD , Yihua Guo MD , Linna Jiao MD

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引用次数: 0

Abstract

Background

Ischemic stroke often results in persistent motor impairments due to disrupted cortical excitability in the lesional hemisphere. Acupuncture and repetitive transcranial magnetic stimulation (rTMS) have each shown potential in enhancing neural plasticity. Their combination may provide synergistic effects, but no meta-analysis has specifically examined objective neurophysiological outcomes.

Objective

To evaluate the efficacy of acupuncture combined with rTMS in improving cortical excitability after ischemic stroke using neurophysiological indicators.

Methods

A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. PubMed, Embase, Web of Science, and Cochrane Library were searched up to June 30, 2025. Randomized controlled trials (RCTs) comparing acupuncture+rTMS with rTMS alone, acupuncture alone, sham stimulation, or conventional rehabilitation, and reporting at least one cortical excitability indicator—motor evoked potential (MEP) amplitude or latency, resting motor threshold (RMT), or central motor conduction time (CMCT)—were included. Risk of bias was assessed with the Cochrane tool, and trial sequential analysis (TSA) was performed.

Results

Twelve RCTs involving 1,012 patients were included. Compared with controls, acupuncture+rTMS significantly increased MEP amplitude (SMD = 1.08, 95 % CI: 0.90–1.26), decreased MEP latency (SMD = –0.90, 95 % CI:1.13 to –0.66), reduced RMT (SMD = –0.76, 95 % CI:0.99 to –0.53), and shortened CMCT (SMD = –0.83, 95 % CI:1.14 to –0.52), all with low heterogeneity (I² = 0–20.4 %). TSA showed that the cumulative Z-curve crossed the monitoring boundary but the required information size (RIS = 1,268) was not reached, indicating that while the current evidence is promising, further adequately powered randomized controlled trials are still required.

Conclusions

Acupuncture combined with rTMS significantly enhances cortical excitability after ischemic stroke, supporting its value in neurorehabilitation. Larger, standardized trials are warranted to confirm these findings and evaluate long-term benefits.

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针刺联合重复经颅磁刺激增强缺血性脑卒中后病变半球皮层兴奋性：系统回顾和荟萃分析。

背景：缺血性中风通常会导致持续性运动障碍，这是由于病变半球皮层兴奋性的破坏。针刺和重复经颅磁刺激（rTMS）均显示出增强神经可塑性的潜力。它们的组合可能提供协同效应，但没有荟萃分析专门检查客观神经生理结果。目的：应用神经生理指标评价针刺联合rTMS对缺血性脑卒中后皮质兴奋性的改善作用。方法：根据PRISMA 2020指南进行系统评价和荟萃分析。PubMed、Embase、Web of Science和Cochrane Library的检索截止日期为2025年6月30日。随机对照试验（rct）将针灸+rTMS与单独rTMS、单独针灸、假刺激或常规康复进行比较，并报告至少一项皮质兴奋性指标——运动诱发电位（MEP）振幅或潜伏期、静息运动阈值（RMT）或中枢运动传导时间（CMCT）。采用Cochrane工具评估偏倚风险，并进行试验序列分析（TSA）。结果：纳入12项随机对照试验，共1012例患者。与控制相比,针灸+ rTMS显著增加议员振幅(SMD = 1.08,95%置信区间CI: 0.90 - -1.26),减少议员延迟(SMD = -0.90,95%置信区间CI: -1.13 - -0.66),降低了RMT (SMD = -0.76,95%置信区间CI: -0.99 - -0.53),并缩短CMCT (SMD = -0.83,95%置信区间CI: -1.14 - -0.52),所有较低的异质性(I2 = 0 - 20.4%)。TSA显示，累积z曲线跨越了监测边界，但没有达到所需的信息大小（RIS = 1,268），这表明尽管目前的证据是有希望的，但仍需要进一步的充分有力的随机对照试验。结论：针刺联合rTMS可显著增强缺血性脑卒中后皮层兴奋性，支持其在神经康复中的应用价值。有必要进行更大规模的标准化试验来证实这些发现并评估长期效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.