Today, stroke is a leading cause of long-term disability worldwide. Up to half of stroke survivors struggle with continuing disability, and nearly 30% require help getting through daily activities at the sixth-month mark after their stroke. 

For that reason, it is imperative that effective rehabilitation strategies be used to maximize recovery outcomes. Today, TMS has great potential as a non-invasive brain stimulation technique for enhancing stroke recovery and improving functional outcomes.

Efficacy of TMS therapy for stroke recovery

Over the last decade, research into the use of TMS for stroke recovery has increased dramatically. Several potentially useful functions of TMS stroke treatment have emerged.

Mechanisms of TMS in Stroke Recovery

TMS is a painless, non-invasive technique that can target several areas of the brain with simple magnetic pulses at different frequencies. These pulses are administered during short, 20-minute sessions. They can be applied throughout the primary motor cortex to elicit changes brought about by a stroke.

Balance in the brain

Under regular conditions, there is a balance between the hemispheres of the brain which is regulated by something called interhemispheric inhibition. After a stroke, this balance is negatively affected and one hemisphere can face extreme excitability while another faces impaired functionality. In these cases, TMS can modulate excitability throughout different areas of the brain, bringing balance back between the two hemispheres.

Improved control

Motor skills are often impaired after a stroke because they rely on several colonies of neurons responsible for the performance of individual actions. However, the damage to some of these neurons during a stroke means the brain has to create alternative clusters of neurons for the same movements, and this can take time. It can be inhibited by the amount of damage in both hemispheres.

TMS offers an opportunity to target these areas and stimulate blood flow and neural connections where they have previously been damaged, which helps improve motor control.

Efficacy of TMS for Stroke Recovery

But how effective is TMS for stroke recovery? 

TMS stroke and depression recovery

Nearly 50% of stroke survivors struggle with depression, and this leads to a reduced quality of life and adverse outcomes following their stroke. Conventional therapies for post-stroke depression do not work well on all patients. Given that TMS has been established as an FDA-approved, highly effective treatment for major depressive disorder, new research explored the efficacy of TMS for stroke and depression symptoms.

Results indicated that the use of TMS for stroke-related depression caused significant improvements with noticeably decreased depression symptoms. This improvement lasted three months with no adverse effects and high patient tolerability.

TMS and movement-dependent stroke recovery

New evidence has been researched on whether TMS is effective in helping with movement-dependent stroke recovery. For many people, post-stroke motor recovery is significantly impaired, especially in the upper extremities, but necessitates motor skill learning, which involves the primary motor cortex. Theoretically, TMS could offer a way to improve movement in the upper extremities by focusing on the neuroplasticity within the sensorimotor cortex, the area of the primary motor cortex that is often damaged.

Results have found an overall change indicating that targeted TMS in stroke recovery can improve rehabilitation interventions.

TMS and stroke motor recovery

Several studies have performed a comparative analysis of TMS stroke treatment as it relates to motor recovery. Motor potentials evoked by TMS have been shown to offer clinical improvements in several mechanisms among stroke patients.

TMS stroke recovery and motor cortex function

After a stroke, many patients have imbalances between hemispheres, but improvements in the motor cortex can be the most beneficial way to improve several symptoms after a stroke. The reason for this is that the neurophysiological effects of a stroke are generally localized in the motor cortex, and studies have found that TMS can change things like:

• Interhemispheric interaction
• Intracortical function
• Cortical motor excitability

All three of these can improve motor cortex function and rectify imbalances with interhemispheric inhibition following a stroke.

Safety Considerations and Adverse Effects

Several studies confirmed that there are limited side effects associated with TMS for stroke recovery. However, some people still ask, “Can TMS cause a stroke?” or can it make symptoms worse? In those who have had a stroke and are seeking recovery, TMS is well tolerated with limited safety concerns.

There are safety considerations and adverse effects for those who have epilepsy or electrical devices implanted near or in the brain. 

Individualized Treatment Approaches with TMS

Prediction of recovery for those who have had a stroke is very complex, and TMS is an insufficient predictor in isolation. However, when used with other tools like rehabilitation and clinical assessments, TMS can offer better gains for motor function and cortical excitability.

TMS does not offer a permanent solution as the effects achieved through TMS treatment for stroke will naturally adjust to their baseline after an average of 6 months to 1 year. Moreover, TMS should not be relied upon as the only treatment following a stroke. Instead, individuals who have had a stroke or who have family members who have recently had a stroke should consider individualized treatment approaches with TMS.

TMS as an Adjunct to Conventional Rehabilitation

Tangentially, TMS for stroke recovery should be considered an adjunct to conventional rehabilitation. Several studies have confirmed the efficacy of TMS stroke treatment in supporting conventional rehabilitation. 

The more you incorporate TMS into your individualized treatment approach, the more successful conventional rehabilitation will be. Moreover, when you work with your team, you will find that TMS can be adjusted based on changing needs. As things like motor skills improve, TMS sessions can Target different areas of the brain based on individual needs.

Summing Up 

With TMS for stroke recovery, it is imperative that you learn as much as you can and speak with your healthcare team about the potential use of TMS as an adjunct to your conventional rehabilitation. There are different clinical considerations that need to be accounted for when implementing TMS in stroke rehabilitation. Nonetheless, transcranial magnetic stimulation shows great promise as a treatment modality for stroke recovery.