TỔNG QUAN ỨNG DỤNG KÍCH THÍCH TỪ TRƯỜNG XUYÊN SỌ LẬP LẠI (RTMS) TRONG PHỤC HỒI VẬN ĐỘNG SAU ĐỘT QUỴ (2015–2025)

Abstract

Objective: To synthesize current evidence (2015 – 2025) on the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for post-stroke motor rehabilitation. Methods: A scoping review was conducted in accordance with the PRISMA-ScR guideline. PubMed, Google Scholar, and peer-reviewed Vietnamese medical journals were searched for English- and Vietnamese-language publications (2015–2025) using the terms “repetitive transcranial magnetic stimulation”, “rTMS”, “stroke”, and “motor recovery”. Eligible records included original studies (randomized controlled trials [RCTs] and observational designs) and systematic reviews/meta-analyses focusing on motor outcomes after stroke. Results: A total of 30 studies satisfied the inclusion criteria, comprising 27 randomized controlled trials (RCTs), 3 observational studies, and 12 systematic reviews/meta‑analyses. Most trials employed (i) low-frequency (≈ 1 Hz) stimulation over the contralesional primary motor cortex or (ii) high-frequency (5–10 Hz) or intermittent theta-burst stimulation over the ipsilesional cortex, always alongside conventional rehabilitation. Compared with sham or usual care, rTMS produced a mean improvement of approximately 5 points on the Fugl-Meyer Upper-Extremity scale, enhanced muscle strength, and better performance in activities of daily living; benefits were most pronounced within the first six months post-stroke and among participants with severe baseline motor deficits. No serious rTMS-related adverse events were reported; transient headaches and scalp discomfort were the most common minor side-effects. Conclusions: When integrated with standard therapy, rTMS appears to be a safe, promising adjunct that accelerates and amplifies motor recovery after stroke, particularly when initiated early. Large multicentre RCTs and mechanistic studies are warranted to standardise stimulation protocols, refine patient selection, and confirm clinical utility—especially in the Vietnamese context, where controlled trials are still lacking.