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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: = 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.
Li et al. (Mon,) studied this question.