Systematic evaluation and meta-analysis of repeated transcranial magnetic stimulation for epilepsy_Journal of Epilepsy

Authors：

TONG Jingyi ¹ , LI Changxuan ¹ , LIU Yonghong ² , LIU Hui ¹ , MA Lin ¹ ,  LI Qifu ¹

1. Department of Neurology, second ward, the First Affiliated Hospital of Hainan Medical College, Haikou 570100, China;
2. Department of Neurology, Leshan Geriatric Hospital, Leshan 614900, China;

Corresponding author：

LI Qifu, Email: lee-chief@163.com

Keywords：

repetitive Transcranial magnetic stimulation; Epilepsy; Anxiety depression comorbidity; Epilepsy with cerebral palsy merger; Adjuvant therapy; Randomized controlled trials

DOI：

10.7507/2096-0247.20190055

Video：

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Objective To systematically evaluate the effect of repeated transcranial magnetic stimulation (rTMS) in treating epilepsy.Methods The randomized controlled trials (RCTs) of rTMS for epilepsy and related diseases were collected from PubMed, EMbase, Cochrane Library, CBM, CNKI, VIP, and Wanfang databases by computer. The retrieval time was from establishment to June 2019. Two researchers independently screened the literature, extracted the data and evaluated the deviation risks of the included studies. RevMan5.3 software was used for Meta analysis.Results A total of 21 RCTs were included, including 1 587 patients. The results showed that rTMS assisted antiepileptics drugs (AEDs) could improve the effective rate of epilepsy treatment [RR=1.28, 95% CI (1.19, 1.37)], significantly reduced HAMA, HAMD and NFDS scores in the treatment of patients with epilepsy combined with anxiety and depression [MD=−3.94, 95% CI (−4.25, −3.63)], and improve DQ and GMFM-88 scores in children with cerebral palsy combined with epilepsy [MD=7.95, 95% CI (7.00, 8.90)]. In addition, using rTMS will not cause additional adverse reaction [peto OR=0.52, 95% CI (0.31, 0.84)].Conclusions The current evidence showed that rTMS combined AEDs can improve the efficient of AEDs therapy. When treat anxiety depression comorbidity, it can significantly reduce the anxiety depression score. In addition in children with cerebral palsy merger, it can improve muscle strength and development. And rTMS will not cause additional adverse reactions. Limited by the quantity and quality of the selected studies, the conclusions need to be verified by more high-quality studies.

Citation： TONG Jingyi, LI Changxuan, LIU Yonghong, LIU Hui, MA Lin, LI Qifu. Systematic evaluation and meta-analysis of repeated transcranial magnetic stimulation for epilepsy. Journal of Epilepsy, 2019, 5(5): 338-350. doi: 10.7507/2096-0247.20190055 Copy

1.	李艳. 癫痫发病机制及治疗的研究进展. 医学食疗与健康, 2018, 10(11): 166-168.
2.	Rybka S, Obniska J, Rapacz A, et al. Synthesis, Physicochemical, and anticonvulsant properties of new N-mannich bases derived from pyrrolidine-2, 5-dione and Its 3-methyl analog. Arch Pharm (Weinheim), 2014, 347(10): 768-776.
3.	杨敏玲, 肖农. 小儿脑性瘫痪共患癫痫研究进展. 中华实用儿科临床杂志, 2017, 32(11): 878-880.
4.	Gersner R, Dhamne SC, Zangen A, et al. Bursts of high-frequency repetitive transcranial magnetic stimulation (rTMS), together with lorazepam, suppress seizures in a rat kainate status epilepticus model. Epilepsy Behav, 2016, 9(62): 136-139.
5.	Guse B, Falkai P, Wobrock T. Cognitive effects of high-frequency repetitive transcranial magnetic stimulation: a systematic review. Journal of Neural Transmission, 2010, 117(1): 105-122.
6.	马改霞, 卢瑞峰. 经颅磁刺激用于口服卡马西平癫痫患者的疗效及安全性评价. 临床研究, 2019, 27(5): 72-74.
7.	黄莺莺. 经颅磁刺激疗法治疗癫痫的效果探究. 当代医药论丛, 2018, 16(3): 99-101.
8.	赵征. 经颅磁刺激治疗配合抗癫痫药物治疗癫痫患儿 60 例临床效果观察. 医药论坛杂志, 2018, 39(4): 150-152.
9.	臧轲君. 双侧小脑高频重复经颅磁刺激治疗难治性癫痫的随机双盲对照研究. 山东大学(硕士学位论文), 2018: 13-22.
10.	赖明君, 李泽, 邓慧琨, 等. 重复经颅磁刺激(rTMS)治疗难治性癫痫的疗效及对认知功能的影响. 齐齐哈尔医学院学报, 2018, 39(16): 1897-1898.
11.	赵红艳, 郑文权, 马建功. 左乙拉西坦与醒脑静联合重复经颅磁刺激治疗癫痫临床观察. 中国实用神经疾病杂志, 2018, 21(05): 491-495.
12.	袁婕, 崔小丽, 李红, 等. 经颅磁刺激联合丙戊酸钠注射液治疗癫痫持续状态的效果分析. 现代生物医学进展, 2018, 18(20): 3913-3916.
13.	安影丹, 李令娟. 重复经颅磁刺激对脑卒中后癫痫合并焦虑抑郁共病病人去甲肾上腺素及 5-羟色胺的调节作用. 中西医结合心脑血管病杂志, 2018, 16(19): 2889-2891.
14.	张塬坤, 李楠, 董万亮, 等. 重复经颅磁刺激治疗冠心病合并脑梗死迟发性癫痫患者焦虑抑郁共病. 中国实用神经疾病杂志, 2018, 21(22): 2482-2486.
15.	魏抗洪. rTMS 联合康复训练治疗脑瘫并发癫痫的效果观察. 中国民康医学, 2018, 30(13): 82-84.
16.	张风林, 柳惠青, 姚玮, 等. 经颅磁刺激联合医痫丸辅助治疗颅脑外伤继发性癫痫效果观察. 山东医药, 2017, 57(20): 52-54.
17.	张桂玲. 重复经颅磁刺激治疗脑卒中后迟发性癫痫患者的不良效果观察. 世界最新医学信息文摘, 2017, 17(22): 130.
18.	王桂贤. 康复训练配合重复经颅磁刺激对脑瘫并发癫痫患儿运动功能的影响. 现代诊断与治疗, 2017, 28(18): 3354-3355.
19.	田继刚. 应用经颅磁刺激治疗癫痫的临床疗效及安全性分析. 中国社区医师, 2016, 32(31): 59-60.
20.	李庆全. 重复经颅磁刺激治疗脑卒中后迟发性癫痫患者焦虑抑郁共病的疗效. 中国实用神经疾病杂志, 2016, 19(15): 114-115.
21.	杨霄鹏, 杨颜滋, 杨瑞玲. 重复经颅磁刺激治疗癫痫的临床疗效及安全性分析. 中国实用神经疾病杂志, 2016, 19(12): 85-86.
22.	符惠芳. 重复经颅磁刺激治疗脑卒中后迟发性癫痫患者焦虑抑郁共病的疗效观察. 中国实用神经疾病杂志, 2015, 21(1): 90-92.
23.	王迎红, 马丙祥. 重复经颅磁刺激对脑性瘫痪并发癫痫患儿智力发育的影响. 中国康复理论与实践, 2014, (12): 1153-1155.
24.	单峤, 王世勋, 王新军. 重复经颅磁刺激治疗脑卒中后迟发性癫痫患者焦虑抑郁共病的疗效. 实用医学杂志, 2013, 29(24): 4000-4003.
25.	Cantello R, Rossi S, Varrasi C. Slow repetitive TMS for drug-resistant epilepsy: clinical and EEG findings of a placebo-controlled trial. Epilepsia, 2007, 48(2): 366-374.
26.	Theodore WH, Hunter K, Chen R, et al. Transcranial magnetic stimulation for the treatment of seizures: a controlled study. Neurology, 2002, 59(4): 560-562.
27.	王梦, 潘小平. 经颅磁刺激在癫痫研究与治疗中的应用. 实用医院临床杂志志, 2014, 12(3): 210-214.
28.	Palanisamy A, Rajendran NN, Narmadha MP, et al. Association of apolipoprotein Eε4 allele with cognitive impairment in patients with epilepsy and interaction with phenytoin monotherapy. Epilepsy Behav, 2013, 26(2): 165-169.
29.	Hammoud MZ, Milad MR. Symptom changes in posttraumatic stress disorder and major depressive disorder after transcranial magnetic stimulation: mechanisms of where and how in the brain. Biol Psychiatry, 2018, 83(3): 200-202.

1. 李艳. 癫痫发病机制及治疗的研究进展. 医学食疗与健康, 2018, 10(11): 166-168.
2. Rybka S, Obniska J, Rapacz A, et al. Synthesis, Physicochemical, and anticonvulsant properties of new N-mannich bases derived from pyrrolidine-2, 5-dione and Its 3-methyl analog. Arch Pharm (Weinheim), 2014, 347(10): 768-776.
3. 杨敏玲, 肖农. 小儿脑性瘫痪共患癫痫研究进展. 中华实用儿科临床杂志, 2017, 32(11): 878-880.
4. Gersner R, Dhamne SC, Zangen A, et al. Bursts of high-frequency repetitive transcranial magnetic stimulation (rTMS), together with lorazepam, suppress seizures in a rat kainate status epilepticus model. Epilepsy Behav, 2016, 9(62): 136-139.
5. Guse B, Falkai P, Wobrock T. Cognitive effects of high-frequency repetitive transcranial magnetic stimulation: a systematic review. Journal of Neural Transmission, 2010, 117(1): 105-122.
6. 马改霞, 卢瑞峰. 经颅磁刺激用于口服卡马西平癫痫患者的疗效及安全性评价. 临床研究, 2019, 27(5): 72-74.
7. 黄莺莺. 经颅磁刺激疗法治疗癫痫的效果探究. 当代医药论丛, 2018, 16(3): 99-101.
8. 赵征. 经颅磁刺激治疗配合抗癫痫药物治疗癫痫患儿 60 例临床效果观察. 医药论坛杂志, 2018, 39(4): 150-152.
9. 臧轲君. 双侧小脑高频重复经颅磁刺激治疗难治性癫痫的随机双盲对照研究. 山东大学(硕士学位论文), 2018: 13-22.
10. 赖明君, 李泽, 邓慧琨, 等. 重复经颅磁刺激(rTMS)治疗难治性癫痫的疗效及对认知功能的影响. 齐齐哈尔医学院学报, 2018, 39(16): 1897-1898.
11. 赵红艳, 郑文权, 马建功. 左乙拉西坦与醒脑静联合重复经颅磁刺激治疗癫痫临床观察. 中国实用神经疾病杂志, 2018, 21(05): 491-495.
12. 袁婕, 崔小丽, 李红, 等. 经颅磁刺激联合丙戊酸钠注射液治疗癫痫持续状态的效果分析. 现代生物医学进展, 2018, 18(20): 3913-3916.
13. 安影丹, 李令娟. 重复经颅磁刺激对脑卒中后癫痫合并焦虑抑郁共病病人去甲肾上腺素及 5-羟色胺的调节作用. 中西医结合心脑血管病杂志, 2018, 16(19): 2889-2891.
14. 张塬坤, 李楠, 董万亮, 等. 重复经颅磁刺激治疗冠心病合并脑梗死迟发性癫痫患者焦虑抑郁共病. 中国实用神经疾病杂志, 2018, 21(22): 2482-2486.
15. 魏抗洪. rTMS 联合康复训练治疗脑瘫并发癫痫的效果观察. 中国民康医学, 2018, 30(13): 82-84.
16. 张风林, 柳惠青, 姚玮, 等. 经颅磁刺激联合医痫丸辅助治疗颅脑外伤继发性癫痫效果观察. 山东医药, 2017, 57(20): 52-54.
17. 张桂玲. 重复经颅磁刺激治疗脑卒中后迟发性癫痫患者的不良效果观察. 世界最新医学信息文摘, 2017, 17(22): 130.
18. 王桂贤. 康复训练配合重复经颅磁刺激对脑瘫并发癫痫患儿运动功能的影响. 现代诊断与治疗, 2017, 28(18): 3354-3355.
19. 田继刚. 应用经颅磁刺激治疗癫痫的临床疗效及安全性分析. 中国社区医师, 2016, 32(31): 59-60.
20. 李庆全. 重复经颅磁刺激治疗脑卒中后迟发性癫痫患者焦虑抑郁共病的疗效. 中国实用神经疾病杂志, 2016, 19(15): 114-115.
21. 杨霄鹏, 杨颜滋, 杨瑞玲. 重复经颅磁刺激治疗癫痫的临床疗效及安全性分析. 中国实用神经疾病杂志, 2016, 19(12): 85-86.
22. 符惠芳. 重复经颅磁刺激治疗脑卒中后迟发性癫痫患者焦虑抑郁共病的疗效观察. 中国实用神经疾病杂志, 2015, 21(1): 90-92.
23. 王迎红, 马丙祥. 重复经颅磁刺激对脑性瘫痪并发癫痫患儿智力发育的影响. 中国康复理论与实践, 2014, (12): 1153-1155.
24. 单峤, 王世勋, 王新军. 重复经颅磁刺激治疗脑卒中后迟发性癫痫患者焦虑抑郁共病的疗效. 实用医学杂志, 2013, 29(24): 4000-4003.
25. Cantello R, Rossi S, Varrasi C. Slow repetitive TMS for drug-resistant epilepsy: clinical and EEG findings of a placebo-controlled trial. Epilepsia, 2007, 48(2): 366-374.
26. Theodore WH, Hunter K, Chen R, et al. Transcranial magnetic stimulation for the treatment of seizures: a controlled study. Neurology, 2002, 59(4): 560-562.
27. 王梦, 潘小平. 经颅磁刺激在癫痫研究与治疗中的应用. 实用医院临床杂志志, 2014, 12(3): 210-214.
28. Palanisamy A, Rajendran NN, Narmadha MP, et al. Association of apolipoprotein Eε4 allele with cognitive impairment in patients with epilepsy and interaction with phenytoin monotherapy. Epilepsy Behav, 2013, 26(2): 165-169.
29. Hammoud MZ, Milad MR. Symptom changes in posttraumatic stress disorder and major depressive disorder after transcranial magnetic stimulation: mechanisms of where and how in the brain. Biol Psychiatry, 2018, 83(3): 200-202.

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Systematic evaluation and meta-analysis of repeated transcranial magnetic stimulation for epilepsy

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