Hao Zilong, Wang Deren, Zeng Yan, Liu Ming
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Cochrane Database Syst Rev. 2013 May 31;2013(5):CD008862. doi: 10.1002/14651858.CD008862.pub2.
It had been assumed that suppressing the undamaged contralesional motor cortex by repetitive low-frequency transcranial magnetic stimulation (rTMS) or increasing the excitability of the damaged hemisphere cortex by high-frequency rTMS will promote function recovery after stroke.
To assess the efficacy and safety of rTMS for improving function in people with stroke.
We searched the Cochrane Stroke Group Trials Register (April 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), the Chinese Stroke Trials Register (April 2012), MEDLINE (1950 to May 2012), EMBASE (1980 to May 2012), Science Citation Index (1981 to April 2012), Conference Proceedings Citation Index-Science (1990 to April 2012), CINAHL (1982 to May 2012), AMED (1985 to May 2012), PEDro (April 2012), REHABDATA (April 2012) and CIRRIE Database of International Rehabilitation Research (April 2012). In addition, we searched five Chinese databases, ongoing trials registers and relevant reference lists.
We included randomised controlled trials comparing rTMS therapy with sham therapy or no therapy. We excluded trials that reported only laboratory parameters.
Two review authors independently selected trials, assessed trial quality and extracted the data. We resolved disagreements by discussion.
We included 19 trials involving a total of 588 participants in this review. Two heterogenous trials with a total of 183 participants showed that rTMS treatment was not associated with a significant increase in the Barthel Index score (mean difference (MD) 15.92, 95% CI -2.11 to 33.95). Four trials with a total of 73 participants were not found to have a statistically significant effect on motor function (standardised mean difference (SMD) 0.51, 95% CI -0.99 to 2.01). Subgroup analyses of different stimulation frequencies or duration of illness also showed no significant difference. Few mild adverse events were observed in the rTMS groups, with the most common events being transient or mild headaches (2.4%, 8/327) and local discomfort at the site of the stimulation.
AUTHORS' CONCLUSIONS: Current evidence does not support the routine use of rTMS for the treatment of stroke. Further trials with larger sample sizes are needed to determine a suitable rTMS protocol and the long-term functional outcome.
人们曾认为，通过重复低频经颅磁刺激（rTMS）抑制未受损的对侧运动皮层，或通过高频rTMS提高受损半球皮层的兴奋性，将促进中风后的功能恢复。
评估rTMS改善中风患者功能的疗效和安全性。
我们检索了Cochrane中风组试验注册库（2012年4月）、Cochrane对照试验中央注册库（CENTRAL）（《Cochrane图书馆》2012年第4期）、中国中风试验注册库（2012年4月）、MEDLINE（1950年至2012年5月）、EMBASE（1980年至2012年5月）、科学引文索引（1981年至2012年4月）、会议论文引文索引 - 科学版（1990年至2012年4月）、CINAHL（1982年至2012年5月）、AMED（1985年至2012年5月）、PEDro（2012年4月）、REHABDATA（2012年4月）以及国际康复研究CIRRIE数据库（2012年4月）。此外，我们还检索了五个中文数据库、正在进行的试验注册库以及相关参考文献列表。
我们纳入了比较rTMS治疗与假治疗或不治疗的随机对照试验。我们排除了仅报告实验室参数的试验。
两位综述作者独立选择试验、评估试验质量并提取数据。我们通过讨论解决分歧。
本综述纳入了19项试验，共涉及588名参与者。两项共183名参与者的异质性试验表明，rTMS治疗与Barthel指数评分的显著增加无关（平均差（MD）15.92，95%置信区间 -2.11至33.95）。四项共73名参与者的试验未发现对运动功能有统计学显著影响（标准化平均差（SMD）0.51，95%置信区间 -0.99至2.01）。不同刺激频率或病程的亚组分析也未显示出显著差异。在rTMS组中观察到的不良事件较少且轻微，最常见的事件是短暂性或轻度头痛（2.4%，8/327）以及刺激部位的局部不适。
目前的证据不支持常规使用rTMS治疗中风。需要进行更大样本量的进一步试验，以确定合适的rTMS方案和长期功能结局。
