Effects of rTMS over the supplementary motor area on balance and postural control in stroke patients: a randomized controlled trial

The study aims to investigate the effects of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) targeting the SMA on balance and postural control in stroke survivors. We hypothesize that HF-rTMS will enhance balance and posture control while improving corticospinal tract excitability.

This study included 40 patients with balance disorders who were randomly assigned to either the TMS group (n=20) or the sham group (n=20). Both groups participated in a standardized two-week physical therapy program consisting of five sessions per week. Prior to each therapy session, the TMS group received HF-rTMS at 10 Hz with 1000 pulses over the SMA, while the sham group received sham stimulation that mimicked the procedure without delivering actual magnetic pulses. The primary outcome measure was the Berg Balance Scale (BBS), while secondary outcomes included the Trunk Impairment Scale (TIS), Postural Assessment Scale for Stroke Patients (PASS), active motor threshold (AMT), and the amplitude of motor evoked potentials (MEPs). Assessments were conducted at baseline and after the completion of 10 intervention sessions to evaluate changes in balance and postural control. Statistical analysis was performed using a 2 × 2 mixed repeated measures ANOVA to assess the effects of the interventions within groups and between subjects, allowing for a comprehensive evaluation of the outcomes across both groups.

There were statistically meaningful group-by-time interactions on the BBS (p = 0.001, F = 31.25) , TIS ( p = 0.002, F = 24.62) and PASS (p = 0.001, F= 13.02). No significant group effect or group-by-time interaction was detected for AMT and  MEP amplitude.

The study suggest that the application of HF-rTMS over the SMA can result in a significant enhancement of balance and postural control among stroke patients. Nonetheless, it is crucial to acknowledge that further high-quality investigations are imperative to comprehensively investigate the enduring effects of HF-rTMS over the SMA in stroke patients.

SMA rTMS can significantly enhance balance and postural control in patients with stroke. Therefore, rehabilitation professionals should consider integrating rTMS into therapy protocols to provide additional benefits for improving postural stability and functional outcomes in individuals with balance impairments following a stroke.