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

To investigate the effects of 10 Hz repetitive transcranial magnetic stimulation (rTMS) targeting the supplementary motor area (SMA) on balance and postural control in patients with stroke. In this randomized controlled trial, 40 patients withbalance disorders were randomly assigned to either the transcranial magneticstimulation (TMS) group (n = 20) or the sham group (n = 20). Both groups underwent a two-week standardized physical therapy. Before each session, the TMS groupreceived 10 Hz, 1000pulses of TMS over the SMA, while the sham group receivedsham stimulation. The primary outcome was the Berg Balance Scale (BBS).Secondary outcomes included the Trunk Impairment Scale (TIS), PosturalAssessment Scale for Stroke Patients (PASS), active motor threshold (AMT) andmotor evoked potential (MEP) amplitude. Measurements were taken before andafter 10 sessions of interventions. The analysis used a 2 × 2 mixed repeatedmeasures ANOVA to assess the effects of the interventionswithin groups and between subjects. There were statistically meaningful group-by-timeinteractions 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 orgroup-by-time interaction was detected for AMT and MEP amplitude. The study suggests that the applying 10 Hz rTMS over theSMA can significantly enhance balance and postural control in patients withstroke.