Efficacy and Modulating Factors of Repetitive Transcranial Magnetic Stimulation on Motor Function in Parkinson's Disease: A Meta‐Analysis

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OBJECTIVE: This meta-analysis aimed to evaluate the short-term and long-term therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on motor function in patients with Parkinson's disease (PD) and to investigate the potential factors affecting rTMS treatment outcome, including stimulation site, coil type, stimulation frequency, treatment regimen frequency and stimulation pulse number. METHODS: A comprehensive literature search was performed systematically across PubMed, EMBASE, MEDLINE, the Cochrane Library, and Web of Science. Only English-language studies comparing rTMS with sham stimulation were included. Standardized mean difference (SMD) was applied as effect sizes. The Minimum Clinically Important Difference (MCID) was applied to interpret the clinical relevance of findings. RESULTS: Twelve studies comprising 457 patients were included. Using a random-effects model, active rTMS reduced Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) scores compared with sham stimulation (SMD = -0.40, 95% CI: -0.59 to -0.21, p < 0.0001). Long-term benefits were also observed, with a modest improvement in UPDRS-III scores at 1-month follow-up compared with baseline (SMD = -0.43, 95% CI: -0.67 to -0.19, p = 0.0004). Subgroup analyses suggested moderate-to-large effects for daily stimulation protocols (SMD = -0.67, 95% CI: -1.12 to -0.22, p = 0.003). According to the GRADE criteria, the overall quality of evidence was rated as moderate. DISCUSSION: The pooled evidence supports the short-term and long-term efficacy of rTMS in improving motor performance among Parkinson's patients. Based on current evidence, an rTMS protocol involving daily consecutive stimulation may yield therapeutic benefits. TRIAL REGISTRATION: Our meta-analysis is registered with PROSPERO (registration number: CRD420250655158).

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