To evaluate the clinical efficacy of different frequencies of repetitive transcranial magnetic stimulation (rTMS) combined with lower-limb robotic training on cortical excitability and motor function in stroke patients.

Ninety patients with stroke hospitalized in the Affiliated Hospital of Jining Medical University from January 2024 to January 2025 were randomly assigned to Groups A (n=30), B (n=30) and C (n=30). All groups received conventional rehabilitation therapy. Concurrently, Group A underwent lower limb robotic training; Group B received low-frequency (1 Hz) rTMS combined with lower-limb robotic training; and Group C received high-frequency (10 Hz) rTMS combined with robotic training. The treatment cycle lasted four weeks. Cortical excitability was assessed before and after treatment by measuring motor evoked potential (MEP) latency and central motor conduction time (CMCT). Motor function was evaluated using the Berg balance scale (BBS), Pro-kin balance tester (measuring trajectory length and ellipse area), Fugl-Meyer assessment for lower extremity (FMA-LE), and functional ambulation category (FAC) scale. The one-way ANOVA and χ² test were used for intergroup comparisons.

(1) After 4 weeks of treatment, all three groups demonstrated significant improvements in MEP latency and CMCT compared to baseline (all P<0.05). Intergroup comparisons revealed that both Group B and Group C patients showed significantly better MEP latency and CMCT than Group A, while Group B patients exhibited significantly better MEP latency and CMCT than Group C. All differences were statistically significant (all P<0.05). (2) After 4 weeks of treatment, all three groups demonstrated significant improvements in motor function outcomes——BBS scores, gait path length, gait ellipse area, FMA-LE, and FAC compared to baseline (all P<0.05). Groups B and C showed significantly superior outcomes across these measures compared to Group A (all P<0.05), though no statistically significant differences were observed between Groups B and C in any motor function measure (all P>0.05).

The short-term efficacy of low-frequency and high-frequency rTMS combined with lower limb robotic therapy on motor function in stroke patients is comparable. However, low-frequency rTMS demonstrates more effective capacity than high-frequency rTMS in enhancing cortical excitability on the lesion side. Clinically, low-frequency rTMS combined with lower-limb robotic therapy is recommended for improving motor function in stroke patients.