Neurogenic overactive bladder (OAB) among survivors is burdensome. Low-frequency repetitive transcranial magnetic stimulation (rTMS) is a promising non-invasive intervention requiring comprehensive evaluation of its clinical and economic impact. ObjectivesTo evaluate the efficacy, cost-utility, and stroke survivors' experiences of rTMS for neurogenic OAB.MethodsIn this randomized, assessor-blinded, sham-controlled trial, 60 stroke survivors with neurogenic OAB received active rTMS (1200 pulses 80% resting motor threshold [RMT]) or sham (20% RMT) thrice weekly for 4 weeks at contralateral primary motor cortex. The OAB Symptom Score (OABSS), Incontinence Quality of Life (I-QOL), and Brief Resilience Scale (BRS)-were measured at baseline, week 4, and week 8. Repeated measures analysis of covariance evaluated effects. Cost-utility analysis used societal costs and quality-adjusted life years (QALYs). Focus groups involved 12 active-group participants.ResultsActive rTMS (n = 30; 60% male; mean age = 62.1 ± 9.5 years) significantly improved OABSS (mean difference [MD] = 1.81 points, 95% confidence interval [CI] [1.42-2.20], P < .001), I-QOL (MD = 17.48 points, 95% CI [14.18-20.79], P < .001), and BRS (MD = 0.25 points, 95% CI [0.09-0.41], P = .002), at weeks 4 and 8 compared to sham (n = 30; 47% male; mean age = 61.7 ± 8.3 years). Active rTMS was associated with lower societal costs (HK$1267.3 vs HK$1839.0) and higher QALYs (0.691 vs 0.571) than sham. Qualitative data indicated excellent tolerability, symptom relief, and acceptability.ConclusionsLow-frequency rTMS is clinically effective, safe, acceptable, and potentially cost-saving for post-stroke neurogenic OAB. Larger trials with active comparators and extended follow-up are warranted.Trial RegistrationThis trial was registered at http://ClinicalTrials.gov (reference number: NCT05557175) before the recruitment of the first participant.
Neurorehabilitation and neural repair. 2026 Apr 29 [Epub ahead of print]
Mohammed Usman Ali, Kenneth N K Fong, Georg S Kranz, Jingjing Li, Crystal Kwan, Priya Kannan
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong., Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.