Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating stroke patients with motor dysfunction. Methods The Cochrane Library, MEDLINE, EMbase, CBM, CNKI and WanFang Data were searched from inception to January 2012, and the references of the included studies were also retrieved to collect the randomized controlled trials (RCTs) on rTMS in treating stroke patients with motor dysfunction. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0.2 software, and evidence quality and recommendation level were assessed using the GRADE system. Results A total of 11 RCTs involving 376 patients were included. The results of meta-analysis (including 3 RCTs, low quality) showed that, compared with the routine rehabilitation treatment, 2 to 4 weeks of rTMS was much beneficial to stroke patients with motor dysfunction, with significant differences (WMD=11.02, 95%CI 2.56 to 19.47). The other 8 studies only adopted descriptive analysis accordingly. Conclusion It is still uncertain of the effectiveness of rTMS in improving motor dysfunction of stroke patients, so rTMS should be applied with caution in clinic.
Objective To systematically review the efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) compared with sham therapy for the treatment of major depressive disorder. Methods The Cochrane Library, Medline, EMbase, CBMdisk, CNKI and VIP were searched through computer from 1985 to 2011. The review included RCTs comparing the treatment efficacy of low-frequency rTMS located on right dorsolateral prefrontal cortex (DLPFC) with sham stimulation in the patients suffering major depressive disorder. The quality of the included RCTs was strictly evaluated and the data were extracted by two reviewers independently. The extracted data were analyzed by RevMan 4.2. Results Among seven double-blinded RCTs involving 234 patients included, 1 was A level in quality, 5 were B level, and 1 was C level according to the outcomes of quality evaluation. The results of Meta-analysis indicated that low frequency rTMS was superior to sham stimulation in remission rates after two weeks’ treatment (RR=3.11, 95%CI 1.56 to 6.19). Additionally, low frequency rTMS was lower than the sham stimulation in the scores of HDRS and MADRS (WMD= –6.41, 95%CI –9.32 to –3.50, and WMD= –5.27, 95%CI –9.08 to –1.46, respectively). But no significant difference in response rates between the low prequency rTMS group and the sham group was found (RR=1.72, 95%CI 0.74 to 4.01). There were no severe and intolerable side effects reported in these seven studies. Conclusion The low frequency rTMS as a non-invasive and safe technique may appear to be effective for the treatment of major depressive disorder according to the positive results but the conclusion is not definite because of negative results. This review suggests that parameters could be sited as frequency: 1 Hz, intensity: 90%-110% motor threshold (MT), location: right DLPFC and duration: 2 weeks. Nevertheless, further multicenter and high quality studies are needed before it is used as a first-line treatment for major depressive disorder.
Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for treating dysfunction in patients with Parkinson’s disease (PD). Methods We searched the Cochrane Library (Issue 1, 2010), MEDLINE, EMbase, CBMdisc, and CNKI from the date of the database establishment to April 2010. Randomized controlled trials (RCTs) of rTMS for patients with PD were collected. The quality of the included RCTs was critically appraised and data were extracted by two reviewers independently. Meta-analyses were conducted for the eligible RCTs. Results Eight RCTs were included. The pooled results of the first 2 RCTs showed that, there was no significant difference compared with control group about treating PD patients with clinical motor dysfunction by high-frequency rTMS 10 days later (WMD= –4.75, 95%CI –13.73 to 4.23). The pooled analysis of another 3 studies showed that, no significant difference were found about improving symptoms with treatment of low-frequency rTMS for 1 month compared with control group (WDM= –8.51, 95%CI –18.48 to 1.46). The pooled analysis of last 3 studies showed that, patient with treatment of low-frequency rTMS for 3 months, had been significantly improved in clinical symptoms such as neurological, behavior and emotional state, clinical motor function, and activities of daily living (WDM= –5.79, 95%CI –8.44 to –1.13). The frontal or motor cortex rTMS manifested as low frequency (≤1Hz), high intensity (≥90% RMT), multi-frequency (≥3 times) and long time (≥3 months) had a positive effect on the clinical symptoms of patients with PD and also had a long-term effect. Conclusions rTMS can improve clinical symptoms and dysfunction of the patients with PD.
ObjectiveTo systematically review the effects of repetitive transcranial magnetic stimulation (rTMS) on stroke patients with aphasia. MethodsDatabases such as PubMed, EMbase, The Cochrane Library (Issue 6, 2014), CBM, CNKI, WanFang Data were searched up to June 2014, for randomized controlled trials (RCTs) about rTMS for stroke patients with aphasia. Two reviewers independently screened literature according to the exclusion and inclusion criteria, extracted data and assessed methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 9 RCTs involving 130 patients were included. The results of meta-analysis showed that compared with the control group, rTMS improved stoke patients' speech function after treatment (WMD=14.36, 95%CI 6.93 to 21.79, P=0.000 2). The results of descriptive analysis showed that, rTMS at Broadmann area 45 (1 Hz, 90% RMT, once 20 or 30 minutes, 2 or 3 weeks as a course with 2-day intervals) possibly had a positive long-term effect on post-stroke patients' speech function. ConclusionrTMS may positively improve stroke patients' speech function. Due to limited quantity and quality of the included studies, more large-scale, multicenter, high quality RCTs are needed to verify the above conclusion.
ObjectiveTo systematically review the efficacy of repetitive transcranial magnetic stimulation (rTMS) on patients with mild cognitive impairment (MCI). MethodsWe searched databases including PubMed, The Cochrane Library (Issue 10, 2015), EMbase, PsycINF, EBSCO, CBM, CNKI, WanFang Data and VIP from inception to October 2015 to collect randomized controlled trials (RCTs) about rTMS for patients with MCI. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 5 RCTs involving 180 MCI patients were included. The results of meta-analysis showed that, compared with the control group, rTMS treatment could significantly improve the overall cognitive abilities of MCI patients (SMD=2.53, 95% CI 0.91 to 4.16, P=0.002), as well as the single-domain cognitive performances, including tests for episodic memory (MD=0.98, 95% CI 0.24 to 1.72, P=0.01) and verbal fluency (MD=2.08, 95% CI 0.46 to 3.69, P=0.01). rTMS was a well-tolerated therapy, with slightly more adverse events observed than the control group (RD=0.09, 95% CI 0.00 to 0.18, P=0.04), but cases were mainly transient headache, dizziness and scalp pain. ConclusionrTMS may benefit the cognitive abilities of MCI patients. Nevertheless, due to the limited quantity and quality of included studies, large-scale, multicenter, and high quality RCTs are required to verify the conclusion.
Repetitive transcranial magnetic stimulation (rTMS) can influence the stimulated brain regions and other distal brain regions connecting to them. The purpose of the study is to investigate the effects of low-frequency rTMS over primary motor cortex on brain by analyzing the brain functional connectivity and coordination between brain regions. 10 healthy subjects were recruited. 1 Hz rTMS was used to stimulate primary motor cortex for 20 min. 1 min resting state electroencephalography (EEG) was collected before and after the stimulation respectively. By performing phase synchronization analysis between the EEG electrodes, the brain functional network and its properties were calculated. Signed-rank test was used for statistical analysis. The result demonstrated that the global phase synchronization in alpha frequency band was decreased significantly after low-frequency rTMS (P<0.05). The phase synchronization was down-regulated between motor cortex and ipsilateral frontal/parietal cortex, and also between contralateral parietal cortex and bilateral frontal cortex. The mean degree and global efficiency of brain functional networks in alpha frequency band were significantly decreased (P<0.05), and the mean shortest path length were significantly increased (P<0.05), which suggested the information transmission of the brain networks and its efficiency was reduced after low-frequency rTMS. This study verified the inhibition function of the low-frequency rTMS to brain activities, and demonstrated that low-frequency rTMS stimulation could affect both stimulating brain regions and distal brain regions connected to them. The findings in this study could be of guidance to clinical application of low-frequency rTMS.
ObjectivesTo systematically review the efficacy of repetitive transcranial magnetic stimulation (rTMS) on rehabilitation of unilateral neglect in stroke patients.MethodsPubMed, The Cochrane Library, PEDro, EMbase, CNKI, WanFang Data and VIP databases were searched online for randomized controlled trials (RCTs) of rTMS on rehabilitation of unilateral neglect in stroke patients from inception to March 2017. Two reviewers independently screened literature, extracted data and assessed the quality of included studies. Meta-analysis was then performed by using RevMan 5.3 software.ResultsA total of 12 RCTs involving 303 patients were included. The results of meta-analysis showed that: the stimulate group was superior to the control group in line bisection test (MD=–5.54, 95%CI –6.79 to –4.29, P<0.000 01), line cancellation test (MD=–3.75, 95%CI –4.60 to –2.90,P<0.000 1) and star cancellation test (MD=–22.94, 95%CI –26.52 to –19.35,P<0.000 01). However, there was no significant difference in the score of the modified Barthel index between two groups (MD=3.91, 95%CI–9.52 to 17.34,P=0.57).ConclusionsrTMS appears to improve the symptoms of unilateral neglect in stroke patients. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusions.
ObjectiveTo systematically evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on post-stroke depression (PSD).MethodsWe searched databases including the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet, Wanfang, China Biology Medicine database and VIP database to collect randomized controlled trials comparing the effect of the rTMS group and the control group with the scores of depression scale from January 2013 to April 2018. Patients in the rTMS group received rTMS plus drug therapy or conventional treatment for PSD, and patients in the control group received rTMS sham stimulation or not, but the drug treatment or routine treatment was required. When the quality evaluation and data extraction were carried out by two reviewers independently, the Meta-analysis was performed using RevMan 5.3 software and Stata 14.0 software.ResultsA total of 18 literatures involving 1 376 patients (687 patients in the rTMS group and 689 patients in the control group) with PSD were included in this Meta-analysis. Compared with the control group, the rTMS group could effectively reduce the depression scores of PSD patients [standard mean difference (SMD)=–1.13, 95% confidence interval (CI) (–1.42, –0.84), P<0.000 01], and the effective rate of rTMS was 91.7%; meanwhile, rTMS could promote the scores of the National Institute of Health Stroke Scale and the activities of daily living of patients with PSD [SMD=–1.00, 95%CI (–1.25, –0.75), P<0.000 01;SMD=1.56, 95%CI (0.80, 2.32), P<0.000 01]. The source of heterogeneity was not found according to subgroup analysis and Meta-regression analysis. Additionally, few studies reported adverse reactions after the treatment of rTMS.ConclusionsrTMS has a positive effect on depression, neurological deficits, and decreased ability of daily living in patients with PSD. Due to the quality of the included studies, the conclusions need to be verified further.