The Efficacy of High-Frequency Repetitive Transcranial Magnetic Stimulation on Upper Extremity Function in Intracerebral hemorrhage: A Real-World Retrospective Cohort Study

Shasha Fan¹Junyan Zhang²Yajuan Li¹Xiangping Li¹Qing Niu¹Ke Zhang³Pingzhi Wang¹Xiaolei Liu^4*

• ¹Department of Rehabilitation Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
• ²Department of Clinical Epidemiology and Evidence-based Medicine, Shanxi Bethune Hospital, Shanxi Medical University, Taiyuan, China
• ³Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
• ⁴Department of Neurology, the First Affiliated Hospital of Kunming Medical University, Kunming, China

Background: Repetitive transcranial magnetic stimulation (rTMS) has been applied to improve upper limb motor recovery following stroke. However, most existing evidence is derived from ischemic stroke populations, with limited studies specifically evaluating its efficacy in intracerebral hemorrhage (ICH). Objective: To explore the efficacy of rTMS on upper extremity function in a cohort exclusively composed of ICH patients, providing real-world evidence on its application in this underrepresented population. Methods: A retrospective cohort study was conducted including 394 patients diagnosed with ICH who were admitted to the Department of Rehabilitation Medicine at Bethune Hospital of Shanxi between January 2020 and June 2023. Patients were divided into two groups: conventional rehabilitation therapy alone or in combination with high-frequency rTMS (HF-rTMS). The primary endpoint was the proportion of patients achieving a clinically meaningful improvement (≥9 points) in the Fugl-Meyer Upper Extremity (FM-UE) Scale. Results: HF-rTMS treatment was significantly associated with an increased likelihood of achieving the primary endpoint (OR = 3.19, 95% CI 1.81–5.65, p < 0.001). Consistent findings were observed in the Overlap-Weighted PSM dataset, where a significantly higher percentage of participants in the HF-rTMS group met the primary endpoint compared to the non-rTMS group (35.29% vs. 20.60%, p = 0.003) confirming the robustness of our results. Conclusion: This large-scale real-world study exclusively focused on ICH provides critical evidence supporting the efficacy of HF-rTMS in subacute ICH rehabilitation. Given the paucity of dedicated research on ICH, these findings offer valuable insights into personalized neuromodulatory treatment strategies for this understudied population.