Aug 2026· Frontiers in Psychology· Vol 17· 0 citations· 43 references
Medicine
TL;DR
Current randomized evidence suggests that rTMS and tDCS may improve depressive symptoms in patients with PSD and appear generally well tolerated, however, the certainty of these findings is limited by substantial heterogeneity, small sample sizes in several trials, and variation in stimulation protocols.
Abstract
Objective Post-stroke depression (PSD) is a common neuropsychiatric complication after stroke and is associated with poorer functional recovery and quality of life. This systematic review and meta-analysis evaluated the efficacy and safety of non-invasive brain stimulation (NIBS), specifically repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), for PSD. Methods PubMed, Embase, Web of Science, the Cochrane Library, and Scopus were searched from inception to April 2025. Randomized controlled trials comparing rTMS or tDCS with sham stimulation, placebo, usual care, or other control interventions in adults with PSD were eligible. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for depressive symptoms and secondary outcomes. Fixed- or random-effects models were selected according to heterogeneity. Results Seventeen randomized controlled trials involving 917 participants were included. Compared with control interventions, NIBS was associated with a greater reduction in depressive symptoms (SMD = −1.24, 95% CI: −1.74 to −0.73, p < 0.001). Subgroup analyses showed significant effects for both rTMS (SMD = −1.06, 95% CI: −1.59 to −0.52) and tDCS (SMD = −1.94, 95% CI: −3.25 to −0.63), although the difference between modalities was not statistically significant. High-frequency rTMS showed a numerically larger effect than low-frequency rTMS, but the subgroup difference was not significant. NIBS was also associated with improvements in activities of daily living (SMD = 0.80) and quality of life (SMD = 0.83). No serious stimulation-related adverse events were reported. Conclusion Current randomized evidence suggests that rTMS and tDCS may improve depressive symptoms in patients with PSD and appear generally well tolerated. However, the certainty of these findings is limited by substantial heterogeneity, small sample sizes in several trials, and variation in stimulation protocols. Further well-designed trials are needed to define optimal stimulation parameters, treatment timing, and long-term clinical effects.
Repetitive transcranial magnetic stimulation (rTMS) is a subcategory of non-invasive brain stimulation (NIBS), used to modulate brain plasticity and improve post-stroke recovery. Neuronavigation is used to improve the accuracy of stimulation with the aim of achieving a superior clinical outcome than with conventional targeting. The objective of this review is to evaluate the efficacy of navigated rTMS in subacute and chronic stroke patients in comparison to sham stimulation. We conducted a systematic-review and meta-analysis of randomized controlled trials (RCTs) identified from Pubmed, Scopus and Cochrane CENTRAL. Trials employing neuronavigated rTMS were included of these five types; high and low frequency rTMS, intermittent and continuous theta-burst stimulation (TBS) and Hebbian-type stimulation. 13 RCTs were included after a screening of 1900 studies. 606 patients receiving either active (n = 360) or sham stimulation (n = 246) were assessed. The pooled standardized mean difference (SMD) favored rTMS over sham SMD = 0.4 (95 %CI: 0.11-0.69), with moderate heterogeneity I2 = 55 %. Among stimulation modalities, continuous TBS showed the largest pooled effect. rTMS was also associated with significant improvements in disability-related outcomes, SMD = 0.61 (95 % CI 0.14-1.08). Navigated rTMS is associated with modest but significant improvements in motor and disability outcomes in subacute and chronic stroke. Large comparative trials are required to clarify the potential added value over conventional targeting approaches.
E. Beris, Parmenion P. Tsitsopoulos, A. Katsanos et al.· Journal of clinical neurosci...· 0 citations
Objective Stroke is highly prevalent among older adults, and age-related reductions in neuroplastic reserve may limit motor recovery. This systematic review and network meta-analysis aimed to compare and rank the effects of noninvasive brain stimulation combined with acupuncture on post-stroke motor recovery, spasticity, balance, and activities of daily living (ADL). Methods PubMed, Embase, the Cochrane Library, Web of Science, Scopus, CNKI, SinoMed, Wanfang, and CQVIP were searched from inception to July 1, 2026. Randomized controlled trials evaluating noninvasive brain stimulation, including TMS-based NIBS or transcranial direct current stimulation, combined with acupuncture or electroacupuncture were included. Pairwise and frequentist random-effects network meta-analyses were performed. Risk of bias was assessed using the Cochrane tool, and confidence in network estimates was evaluated using CINeMA. Results Forty-six randomized controlled trials involving 4,080 participants were included. Combined interventions generally showed greater effects than single-modality therapies or conventional rehabilitation, although heterogeneity was substantial. In the network meta-analysis, both TMS-based NIBS plus acupuncture and tDCS plus acupuncture showed favorable ranking probabilities across several outcomes. tDCS plus acupuncture ranked highly for FMA total, FMA-UE, and ADL, whereas TMS-based NIBS plus acupuncture ranked favorably for FMA-LE, spasticity, and balance. Differences between the two combined regimens were generally not statistically significant. CINeMA indicated moderate, low, or very low confidence across network estimates, with no high-confidence evidence. Conclusion Combined noninvasive brain stimulation and acupuncture may provide additional benefits for post-stroke motor and functional recovery. However, current findings should be interpreted cautiously because of substantial heterogeneity, sparse evidence for some intervention nodes, risk-of-bias concerns, and limited confidence in several network estimates. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251051398, Identifier: CRD420251051398.
Qing-Ping Su, Chang-Mei Lu, Yu-Ping Yang et al.· Frontiers in Neurology· 0 citations
Background: Non-invasive brain stimulation (NIBS) is a promising adjunct for Parkinson’s disease (PD), but variation in modality, target, stimulation dose, outcome selection, and safety reporting has produced uncertain estimates of benefit and risk.Objective: To evaluate the efficacy and safety of sham-controlled NIBS for adults with PD.Methods: PubMed/MEDLINE, Embase, Web of Science, and CENTRAL were searched for randomized parallel-group trials published from 2011 through August 2026. The primary outcome was immediate post-intervention motor impairment. Standardized effects were expressed as Hedges’ g, with negative values favoring active NIBS. Random-effects synthesis used restricted maximum likelihood estimation and Hartung–Knapp confidence intervals. Heterogeneity, prediction intervals, target subgroups, leave-one-out analyses, extreme-effect exclusion, funnel-plot asymmetry, and arm-level safety reporting were examined.Results: Eighteen studies involving 579 participants were included; 17 motor comparisons (n = 561) entered the primary synthesis. Active NIBS improved motor outcomes compared with sham stimulation (g = −0.94, 95% CI [−1.57, −0.30], p = .006), although heterogeneity was substantial(I² = 83.6%; 95% prediction interval, −3.36 to 1.49). The magnetic-stimulation-only estimate was similar (g = −1.01, 95% CI [−1.66, −0.35]). Excluding two extreme effects attenuated the estimate (g = −0.61, 95% CI [−0.97, −0.26]) without changing its direction. All leave-one-out estimates favored active stimulation. One small study supported a mood effect. Safety data were incomplete: trials with complete counts reported no serious adverse events or adverse-event-related withdrawals, but missing arm-level reporting prevented comparative pooling.Conclusions: NIBS, particularly magnetic stimulation, produced an average short-term motor benefit in PD, but marked heterogeneity and incomplete safety reporting limit certainty about effect size, durability, target superiority, and comparative safety.
Kholoud Mousa Abd El-Hamed Soliman· Natural Resources for Human...· 0 citations
OBJECTIVE
To evaluate the efficacy and safety of transcranial direct current stimulation (tDCS) initiated strictly within the acute ischemic stroke.
DESIGN
A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted via PubMed, Embase, and Cochrane Library. Outcomes included neurological deficit, upper limb and lower limb motor function, and functional independence. Data were synthesized using random-effects models to calculate weighted mean differences (WMD) and standardized mean differences (SMD).
RESULTS
Ten RCTs involving 419 participants were included. Active tDCS significantly reduced neurological deficits compared to sham stimulation (WMD=-0.86, 95% CI: -1.38 to -0.34, P=0.001). While tDCS did not significantly improve short-term or long-term upper limb function, it demonstrated a significant improvement on lower limb motor recovery (SMD=3.50, 95% CI: 2.56 to 4.44, P<0.001), which was sustained at follow-up. No significant difference was found in functional independence or safety outcomes between groups.
CONCLUSIONS
tDCS initiated in the acute phase is safe and effective for reducing neurological deficits and enhancing lower limb motor recovery. The discrepancy between lower and upper limb outcomes suggests distinct neuroplastic mechanisms, highlighting the potential of tDCS, particularly bilateral montages, as a targeted intervention for early gait rehabilitation.
Qian-Qian Yao, Xiantong Gao, Quanye Ding et al.· American Journal of Physical...· 0 citations
Background Cognitive impairment is a frequent and disabling consequence of traumatic brain injury (TBI). Non-invasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), has been investigated as a potential adjunctive intervention, but review-level conclusions remain inconsistent. Methods We conducted an umbrella review of published systematic reviews evaluating NIBS for cognitive outcomes after TBI. PubMed, Cochrane Library, Embase, Web of Science, CNKI, and Wanfang were searched from inception to May 2026. The unit of analysis was the systematic review, not individual primary trials. Eligible reviews assessed rTMS, tDCS, or both, and reported cognitive outcomes. Methodological quality was reappraised using AMSTAR-2, and primary-study overlap was assessed from the existing review-by-study citation matrix using corrected covered area (CCA). Where reviews reported quantitative estimates for cognition, these estimates were summarized descriptively at the review level; no de novo primary-study meta-analysis and no independent treatment-effect estimation were performed. The protocol was registered in PROSPERO (CRD420261395308). Results Twenty-nine records were identified. Ten review records were included, consisting of seven core evidence reviews and three supplementary reviews. Eight reviews directly addressed cognitive outcomes, while supplementary reviews provided contextual review-level evidence. Conservative AMSTAR-2 reassessment found no high- or moderate-quality reviews; two were rated low and eight critically low in the complete 10-record assessment. The citation matrix contained 42 unique primary studies and 92 primary-study occurrences across 10 review records, yielding a CCA of 13.23%, consistent with high overlap. Previously published quantitative review-level estimates showed inconsistent directions of evidence and did not demonstrate consistent evidence of an overall cognitive benefit. Conclusion Current review-level evidence does not demonstrate consistent evidence of an overall cognitive benefit of NIBS after TBI. Because available reviews are methodologically limited and clinically heterogeneous, routine use of NIBS for post-TBI cognitive rehabilitation is not supported outside research or carefully selected clinical contexts.
Shou-Li Li, Chong-Yue Liu, Jin-Yue Li et al.· Frontiers in Neurology· 0 citations
Background Transcranial direct current stimulation (tDCS) may improve behavioral signs of consciousness in patients with disorders of consciousness (DoC), but evidence from randomized controlled trials (RCTs) and previous meta-analyses has remained inconsistent. We evaluated the efficacy and safety of tDCS in patients with DoC and explored potential effect modifiers. Methods PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched for RCTs comparing active tDCS with sham stimulation. For crossover trials, only first-period data were extracted. The primary outcome was the change in Coma Recovery Scale–Revised (CRS-R) score. Mean differences (MDs) with 95% confidence intervals (CIs) were pooled across studies. Subgroup analyses were performed according to baseline level of consciousness, etiology, disease duration, stimulation target, and total stimulation dose. Results Fourteen trials including 330 patients were included. Active tDCS was associated with greater improvement in CRS-R change scores than sham stimulation (MD = 1.02, 95% CI 0.43–1.60; p < 0.001). A significant subgroup interaction was observed for etiology (p < 0.001), with significant improvements in patients with traumatic brain injury and cerebrovascular accident, but not in hypoxic–ischemic brain injury. Other analyses suggested trends toward improvement in minimally conscious state, left dorsolateral prefrontal cortex stimulation, and higher total stimulation dose, without significant between-subgroup differences. No definite tDCS-related serious adverse events were reported. Conclusion tDCS may improve the level of consciousness in patients with DoC, with no definite tDCS-related serious adverse events identified. Treatment response may differ by etiology, but this finding requires confirmation because multiple subgroup comparisons were performed. Systematic review registration Identifier CRD420261370518.
Fu-Qiang Wang, Yao-Jiang Li, Li-Xia Deng et al.· Frontiers in Neuroscience· 0 citations
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