Effects of Non-Invasive Brain Stimulation on Balance Control in Patients with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Longtao Zhang¹Yanxiao Sun²Zhihao Diao¹Yifan Jiang¹Yufei Hu¹Yuxia Ma^1,3*

• ¹Shandong University of Traditional Chinese Medicine School of Acupuncture and Tuina, Jinan, China
• ²The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, China
• ³Key Laboratory of Traditional Chinese Medicine Classical Theory, Ministry of Education,Shandong University of Traditional Chinese Medicine, Jinan, China

Objective: This study aims to evaluate the effects of non-invasive brain stimulation on balance control in patients with multiple sclerosis (MS) through a systematic review and meta-analysis. The goal is to identify the most effective treatment strategies and provide valuable evidence for clinical decision-making. Methods: PubMed, Web of Science, Embase, Scopus, Cochrane Library, ClinicalTrials.gov and CNKI Scholar were searched for randomized controlled trials on the effects of NIBS on balance control in patients with MS. The search covered periods from each database's inception to August 11, 2025. Primary outcomes were the Timed Up and Go test and Berg Balance Scale, with adverse events as secondary outcomes. Two reviewers independently carried out literature screening, data extraction, and quality assessment using the Cochrane Risk of Bias tool and GRADE methodology. Data analysis was performed with RevMan 5.4 and StataMP 18. Effect sizes were expressed as risk ratio (binary) or mean difference (continuous), accompanied by 95% confidence intervals. Heterogeneity was examined using subgroup analysis, meta-regression, and sensitivity analysis; publication bias was assessed via funnel plots and Egger’s test. Results: A total of 17 RCTs with 514 patients were included. Meta-analysis showed that NIBS can shorten the time taken for TUG (MD = -1.03, 95% CI [-1.86, -0.20]) and improve BBS scores (MD = 3.35, 95% CI [1.31, 5.39]), indicating that NIBS may improve both dynamic and static balance. Subgroup analysis revealed that interventions lasting ≥4 weeks were associated with a reduction in TUG completion time and an increase in BBS scores. Furthermore, transcranial direct current stimulation (tDCS) demonstrated favorable effects on both TUG and BBS outcomes, while evidence supporting the efficacy of repetitive transcranial magnetic stimulation (rTMS) remained limited. Although adverse events such as itching, warmth, tension, and fatigue were reported in NIBS group, these were generally mild and transient. Conclusion: NIBS is an effective adjunct therapy for improving balance in MS, albeit with mild, transient adverse effects. Current evidence is limited by study heterogeneity and short follow-up. Future large-scale RCTs are needed to confirm long-term efficacy, optimize protocols, and develop individualized strategies.