Repetitive Transcranial Magnetic Stimulation for the Upper Limb Motor Function Improvement after Stroke

Stroke induces structural and functional changes within the cortical motor network of both hemispheres. Repetitive transcranial magnetic stimulation modulates the excitability of the motor cortex and thereby may facilitate motor function and/or recovery of motor function after stroke. Based on a systematic literature search we identified 33 placebo-controlled trials which examined the effectiveness of repetitive transcranial magnetic stimulation in the treatment of impaired hand function following stroke. Despite limitations, the majority of the studies referred to the interhemispheric competition model after stroke to apply repetitive transcranial magnetic stimulation. In a comparative approach, methodology and effectiveness of (a) inhibition of the unaffected hemisphere, (b) facilitation of the affected hemisphere and (c) combined application of repetitive transcranial magnetic stimulation over the affected and unaffected hemispheres to treat impaired hand function after stroke are presented. Problems and limitations of repetitive transcranial magnetic stimulation in stroke rehabilitation are discussed and visions for future clinical research are presented.