Acupuncture combined with repetitive transcranial magnetic stimulation vs repetitive transcranial magnetic stimulation alone for recovery of hemiparesis after ischemic stroke: A systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared acupuncture plus repetitive transcranial magnetic stimulation (rTMS) with rTMS alone for limb motor recovery in patients with hemiparesis after ischemic stroke. It included 30 randomised trials involving 3,261 patients. Combination therapy was associated with higher Fugl-Meyer Assessment scores for total motor function (7 trials, n = 673; mean difference 7.11, 95% CI 5.51-8.70) and improvements in upper- and lower-extremity scores and Barthel Index. Reported adverse events were mild and infrequent, although only a small number of trials reported them.

Key findings

• FMA total score favoured combination therapy: 7 trials, n = 673; MD 7.11, 95% CI 5.51-8.70; I 2 = 48.3%.
• FMA upper-extremity score improved: 14 trials, n = 1,358; MD 8.21, 7.68-8.75; I 2 = 0%.
• FMA lower-extremity score improved: 14 trials, n = 1,489; MD 5.06, 4.42-5.71; I 2 = 71.3%.
• Barthel Index favoured combination therapy: 13 trials, n = 1,203; MD 8.54, 7.61-9.47; I 2 = 38.6%; reported adverse events were mild and infrequent.

Why it matters

Motor impairment and limitations in daily activities are important rehabilitation outcomes after ischemic stroke. The pooled findings suggest that adding acupuncture to rTMS may improve measured motor function and activities of daily living compared with rTMS alone. The results are relevant to evaluating adjunctive rehabilitation approaches, while the limited adverse-event reporting and variability in some outcomes warrant cautious interpretation.

What to keep in mind

Adverse events were reported by only a small number of trials. Heterogeneity was substantial for the lower-extremity FMA outcome (I 2 = 71.3%), and the abstract notes that these gains require further validation.