Authors' objectives: To assess the effectiveness, cost-implication, and safety related to the application of rTMS for the stroke patients.

Authors' results and conclusions: There were fair to good level of evidence retrieved to suggest that rTMS (Lf-rTMS/Hf-rTMS) alone or combined with rehabilitation therapies seemed to be superior to sham or rehabilitative therapies and provide added value in terms of: i. Reducing HAMD score, increasing response rate, and remission rate among patient with post-stroke depression ii. Improving gait, walking cadence and walking speed in stroke patients. However, evidence on balance was inconclusive iii. Promoting lower limb recovery and lower limb activity and also motor function in the upper limb (finger flexibility, hand strength, activity dexterity) iv. Improving picture naming, repetition, writing, and comprehension in aphasic stroke patients v. Improving dysphagia after rTMS treatment when combined with conventional dysphagia therapy (and benefit still present four weeks after the last session of therapy) vi. Reducing hemispatial and unilateral neglect vii. Improving motor evoked potential in both unaffected and affected hemisphere. However, the MEP effect was higher in Hf-rTMS compared to Lf-rTMS viii. Improving the activity of daily living in post-stroke patients ix. Better recovery in a patient with shorter disease duration x. Inconclusive effect on the spasticity There were a few mild adverse events related to application rTMS such as headache, discomfort at the stimulation site, and dizziness. No evidence was retrieved on the cost-effectiveness.

Authors' recommendations: rTMS can be used as an adjunct for the rehabilitation of patients with stroke.

Authors' methods: Electronic databases were searched through the Ovid interface: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) 1946 to May 2020, EBM Reviews - Cochrane Central Register of Controlled Trials – May 2020, EBM Reviews - Cochrane Database of Systematic Reviews - 2005 to May 2020, EBM Reviews - Health Technology Assessment – 4th Quarter 2016, EBM Reviews – NHS Economic Evaluation Database 1st Quarter 2016. Searches were also run in INAHTA database, PubMed database and U.S. Food and Drug Administration (USFDA) website. Google and Google Scholar were also used to search for additional web-based materials and information. Additional articles were identified from reviewing the references of retrieved articles. Last search was conducted on 14th May 2020.

Project Status: Completed

Year Published: 2020

URL for published report: https://www.moh.gov.my/index.php/database_stores/store_view_page/30/356

Requestor: Ministry of Health

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment

Contact Address: Malaysian Health Technology Assessment Section, Ministry of Health Malaysia, Federal Government Administrative Centre, Level 4, Block E1, Parcel E, 62590 Putrajaya Malaysia Tel: +603 8883 1229

Contact Name: htamalaysia@moh.gov.my

Contact Email: htamalaysia@moh.gov.my

Copyright: Malaysian Health Technology Assessment Section (MaHTAS)