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 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.
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.
ObjectiveTo investigate the efficacy of transcranial combined with peripheral repetitive magnetic stimulation on motor dysfunction after stroke.MethodsA total of 40 patients after stroke who were hospitalized in the Department of Rehabilitation Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University between January and December 2019 were selected. The patients were divided into the trial group and the control group by random number table method, with 20 cases in each group. Both groups received conventional rehabilitation and medicine treatment, on that basis, the trial group received repetitive transcranial magnetic stimulation (rTMS) combined with repetitive peripheral magnetic stimulation (rPMS), while the control group received rTMS combined with fake rPMS, both lasted for 2 weeks. Before treatment and 2, 4, 12 weeks after the initiation of treatment, the Fugl-Meyer Assessment (FMA) [including FMA-Upper Limb (FMA-UL), FMA-Lower Limb (FMA-LL)], National Institute of Health Stroke Scale (NIHSS), and Modified Barthel Index (MBI) were used to evaluate the efficacy of rTMS combined with rPMS.ResultsFive patients fell off, and 35 patients were finally included, including 18 in the trial group and 17 in the control group. No adverse reaction occurred during the study. Before treatment, there was no significant difference in FMA, FMA-UL, FMA-LL, NIHSS or MBI scores between the two groups (P>0.05). After treatment, the FMA score of the trial group changed from 36.44±28.59 to 75.56±19.94, and that of the control group changed from 39.05±29.85 to 54.64±23.25; the between-group difference was statistically significant at the end of the 4th and 12th weeks (P<0.05). The FMA-UL score of the trial group changed from 21.39±22.14 to 46.94±15.84, and that of the control group changed from 20.82±20.47 to 31.29±16.98; the between-group difference was statistically significant at the end of the 4th and 12th weeks (P<0.05). The FMA-LL score of the trial group changed from 15.06±9.10 to 28.61±5.69, and that of the control group changed from 18.23±10.33 to 23.35±8.20; the between-group difference was statistically significant at the end of the 12th week (P>0.05). The NIHSS score of the trial group changed from 6.83±4.54 to 2.78±2.05, and that of the control group changed from 6.35±3.67 to 3.94±2.56; the MBI score of the trial group changed from 53.33±17.90 to 83.06±12.50, and that of the control group changed from 60.88±25.45 to 78.82±15.67; there was no statistically significant difference in NIHSS or MBI between the two groups at any timepoint (P>0.05). Except for the FMA-LL of the control group, the other outcome indicators in each group were significantly different after treatment compared with those before treatment (P<0.05).ConclusionsBoth rTMS and rTMS combined with rPMS can improve the limb motor function and activities of daily living of stroke patients. The treatment mode of rTMS combined with rPMS has better effect on motor dysfunction after stroke, which is of great significance for improving the overall rehabilitation effect.
Non-invasive brain stimulation is a technology that uses magnetic field or electric field to act on the brain to adjust the activity of cerebral cortex neurons. It mainly includes transcranial magnetic stimulation and transcranial direct current stimulation. The principle is to accelerate the induction of neuroplasticity by changing the excitability of the cerebral cortex. The characteristics are noninvasive, safe and that the patient can tolerate it. This article mainly introduces the theoretical foundation and mechanisms of non-invasive brain stimulation, and its application and safety in stroke complications, neuropathic pain and epilepsy, and discusses the commonly used treatment regimens of non-invasive brain stimulation in different neurological diseases, in order to provide possible treatment reference for the rehabilitation of neurological diseases.
Objective To evaluate the systematic reviews of repetitive transcranial magnetic stimulation (rTMS) for insomnia, to provide supporting evidence for clinical practice. Methods PubMed, Embase, Web of Science, Cochrane Library, Elsevier Science Direct, China National Knowledge Infrastructure, SinoMed, Wanfang and Chongqing VIP were searched from databases establishment to May 30, 2022, to find systematic reviews on the treatment of insomnia with rTMS as the main method. The methodological quality, reporting quality and evidence quality of outcome indicators were evaluated by AMSTAR 2, PRISMA 2020 and GRADE. Results A total of 4 systematic reviews published between 2018 and 2021 were included. Further analysis showed that one of the systematic reviews had a low AMSTAR 2 quality rating and the remaining systematic reviews were very low. The average PRISMA 2020 score of these 4 systematic reviews was (20.75±3.27) points, of which 3 systematic reviews had some defects in their reports, and the other one had relatively complete reports. The GRADE evidence quality assessment showed that there were 40 outcome indicators in the included literature, of which 3 outcome indicators (sleep quality, the percentage of S2 sleep in total sleep time, and S3 sleep in percentage of total sleep time) were rated as moderate, 17 were rated as low and 20 were rated as very low. Conclusions The treatment of insomnia by rTMS has achieved certain effects in clinical practice, but the systematic review of rTMS as the main intervention measure for insomnia needs to further improve the quality and standardize related research. The clinical application of rTMS for insomnia should be treated as appropriate.
Weightlessness in the space environment affects astronauts’ learning memory and cognitive function. Repetitive transcranial magnetic stimulation has been shown to be effective in improving cognitive dysfunction. In this study, we investigated the effects of repetitive transcranial magnetic stimulation on neural excitability and ion channels in simulated weightlessness mice from a neurophysiological perspective. Young C57 mice were divided into control, hindlimb unloading and magnetic stimulation groups. The mice in the hindlimb unloading and magnetic stimulation groups were treated with hindlimb unloading for 14 days to establish a simulated weightlessness model, while the mice in the magnetic stimulation group were subjected to 14 days of repetitive transcranial magnetic stimulation. Using isolated brain slice patch clamp experiments, the relevant indexes of action potential and the kinetic property changes of voltage-gated sodium and potassium channels were detected to analyze the excitability of neurons and their ion channel mechanisms. The results showed that the behavioral cognitive ability and neuronal excitability of the mice decreased significantly with hindlimb unloading. Repetitive transcranial magnetic stimulation could significantly improve the cognitive impairment and neuroelectrophysiological indexes of the hindlimb unloading mice. Repetitive transcranial magnetic stimulation may change the activation, inactivation and reactivation process of sodium and potassium ion channels by promoting sodium ion outflow and inhibiting potassium ion, and affect the dynamic characteristics of ion channels, so as to enhance the excitability of single neurons and improve the cognitive damage and spatial memory ability of hindlimb unloading mice.
Objective To observe the clinical effect of repetitive transcranial magnetic stimulation (rTMS) combined with balloon dilatation and routine swallowing training on dysphagia caused by cricopharyngeal dysfunction (CPD) after stroke. Methods Patients with dysphagia after stroke who were hospitalized at Hubei Provincial Hospital of Integrated Chinese and Western Medicine between January 2022 and February 2023 were selected. The patients were divided into the trial group and the control group by random number table method. The control group received balloon dilatation and routine swallowing training, and the trial group received rTMS based on the treatment plan of the control group. All patients were treated for 3 weeks. The videofluoroscopic swallowing study (VFSS), Penetration Aspiration Scale (PAS), and Functional Oral Intake Scale (FOIS) were used at pre-therapy and 3 weeks after treatment to assess the improvement of swallowing function. Results A total of 49 patients were included, including 25 in the trial group and 24 in the control group. There was no statistically significant difference in age, gender, course of disease, stroke type, and swallowing function before treatment between the two groups of patients (P>0.05). After 3 weeks of treatment, the VFSS dysphagia scores (Z=−4.465, −4.327, P<0.001) of the trial group and the control group were higher than those before treatment, and the trial group was better than that in the control group (t=2.099, P=0.041). The PAS scores (Z=−4.179, −3.729, P<0.001) and FOIS scores (Z=−4.476, −4.419, P<0.001) of the trial and control groups were improved after treatment, and the improvement of the PAS score (t=−2.088, P=0.042) and FOIS score (Z=−2.134, P=0.033) in the trial group were more significant (P<0.05). No serious adverse reactions were observed in patients during the study process. Conclusion The rTMS combined with balloon dilatation and routine swallowing training can significantly improve the swallowing function of patients with dysphagia caused by CPD after stroke, and further improve its clinical efficacy, worthy of clinical application.