SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Stroke
The Effect of Repetitive Transcranial Magnetic Stimulation on Balance Function in Stroke Patients: A Systematic Review
Ningling Chen 1
Shuo Xu 1
Yilong Zou 1
ShaoFan Chen 1
Xiujia Luo 2
Zhengcong Zhang 1
Tingting Chen 1
Huijie Zou 1
Xiaofen Xu 1
Haoqing Jiang 1
1. Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou affiliated Hospital of Fujian Medical University, Zhangzhou, China
2. Shanghai University of Sport, Shanghai, China
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Abstract
Background: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and painless central nervous system modulation technique. It has shown promise in improving motor, swallowing, speech, and cognitive function in stroke patients. However, there is a lack of research on improving post-stroke balance function, and the stimulation parameters vary. Objective: To analyze recent randomized controlled studies on the effect of rTMS on balance function in stroke patients, summarize clinical experience, and propose recommended treatment protocols. Study Design: Systematic review. Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled studies on the effects of rTMS/intermittent theta-burst stimulation(iTBS) on balance and lower limb motor function in stroke patients. Results: A total of 18 studies were included. The primary motor cortex (M1) and cerebellum were the most common stimulation targets. Most studies used either low-frequency rTMS (LF-rTMS) or iTBS protocols. The results showed that, compared to the control group, the experimental group had significant improvements in Berg Balance Scale (BBS), Fugl-Meyer Assessment for the Lower Extremity (FMA-LE), and gait parameters (including cadence, stride length, speed, and step length) (P < 0.05). Some studies showed a more significant decrease in the pairwise derived brain symmetry index (pdBSI) in the experimental group (P = 0.026). The increase in Motor evoked potential (MEP) amplitude was lower in the experimental group than in the control group (P = 0.028). Conclusion: rTMS applied to M1 or cerebellum can improve balance function in stroke patients. We provide the following clinical considerations (rather than formal recommendations) based on qualitative synthesis that (1) LF-rTMS on the unaffected side of the M1 or (2) iTBS on the cerebellum.
Summary
Keywords
balance, Gait, iTBS, Lower-Limb Motor Ability, rTMS, Stroke, Systematic review
Received
13 September 2025
Accepted
07 January 2026
Copyright
© 2026 Chen, Xu, Zou, Chen, Luo, Zhang, Chen, Zou, Xu and Jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Haoqing Jiang
Disclaimer
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