Wagle Shukla Aparna, Shuster Jonathan J, Chung Jae Woo, Vaillancourt David E, Patten Carolynn, Ostrem Jill, Okun Michael S
Department of Neurology and Center for Movement Disorders and Neurorestoration, University of Florida, 3450 Hull Road, Gainesville, FL 32607(∗).
Department of Health Outcomes and Policy, Clinical and Translational Science Institute, University of Florida, Gainesville, FL(†).
PM R. 2016 Apr;8(4):356-366. doi: 10.1016/j.pmrj.2015.08.009. Epub 2015 Aug 24.
Several studies have reported repetitive transcranial magnetic stimulation (rTMS) therapy as an effective treatment for the control of motor symptoms in Parkinson disease. The objective of the study is to quantify the overall efficacy of this treatment.
Systematic review and meta-analysis.
We reviewed the literature on clinical rTMS trials in Parkinson disease since the technique was introduced in 1980. We used the following databases: MEDLINE, Web of Science, Cochrane, and CINAHL.
Patients with Parkinson disease who were participating in prospective clinical trials that included an active arm and a control arm and change in motor scores on Unified Parkinson's Disease Rating Scale as the primary outcome. We pooled data from 21 studies that met these criteria. We then analyzed separately the effects of low- and high-frequency rTMS on clinical motor improvements.
The overall pooled mean difference between treatment and control groups in the Unified Parkinson's Disease Rating Scale motor score was significant (4.0 points, 95% confidence interval, 1.5, 6.7; P = .005). rTMS therapy was effective when low-frequency stimulation (≤ 1 Hz) was used with a pooled mean difference of 3.3 points (95% confidence interval 1.6, 5.0; P = .005). There was a trend for significance when high-frequency stimulation (≥ 5 Hz) studies were evaluated with a pooled mean difference of 3.9 points (95% confidence interval, -0.7, 8.5; P = .08). rTMS therapy demonstrated benefits at short-term follow-up (immediately after a treatment protocol) with a pooled mean difference of 3.4 points (95% confidence interval, 0.3, 6.6; P = .03) as well as at long-term follow-up (average follow-up 6 weeks) with mean difference of 4.1 points (95% confidence interval, -0.15, 8.4; P = .05). There were insufficient data to statistically analyze the effects of rTMS when we specifically examined bradykinesia, gait, and levodopa-induced dyskinesia using quantitative methods.
rTMS therapy in patients with Parkinson disease results in mild-to-moderate motor improvements and has the potential to be used as an adjunct therapy for the treatment of Parkinson disease. Future large, sample studies should be designed to isolate the specific clinical features of Parkinson disease that respond well to rTMS therapy.
多项研究报道重复经颅磁刺激（rTMS）疗法是控制帕金森病运动症状的有效治疗方法。本研究的目的是量化这种治疗方法的总体疗效。
系统评价和荟萃分析。
我们检索了自1980年该技术引入以来关于帕金森病临床rTMS试验的文献。我们使用了以下数据库：医学文献数据库（MEDLINE）、科学引文索引（Web of Science）、考克兰系统评价数据库（Cochrane）和护理及健康领域数据库（CINAHL）。
参与前瞻性临床试验的帕金森病患者，这些试验包括一个治疗组和一个对照组，并将统一帕金森病评定量表运动评分的变化作为主要结局指标。我们汇总了符合这些标准的21项研究的数据。然后我们分别分析了低频和高频rTMS对临床运动改善的影响。
治疗组与对照组在统一帕金森病评定量表运动评分上的总体合并平均差异具有统计学意义（4.0分，95%置信区间为1.5至6.7；P = 0.005）。当使用低频刺激（≤1赫兹）时，rTMS疗法有效，合并平均差异为3.3分（95%置信区间为1.6至5.0；P = 0.005）。在评估高频刺激（≥5赫兹）研究时，合并平均差异为3.9分（95%置信区间为-0.7至8.5；P = 0.08），有显著趋势。rTMS疗法在短期随访（治疗方案结束后立即进行）时显示出益处，合并平均差异为3.4分（95%置信区间为0.3至6.6；P = 0.03），在长期随访（平均随访6周）时，平均差异为4.1分（95%置信区间为-0.15至8.4；P = 0.05）。当我们使用定量方法专门研究运动迟缓、步态和左旋多巴诱发的异动症时，没有足够的数据对rTMS的效果进行统计学分析。
帕金森病患者接受rTMS疗法可带来轻度至中度的运动改善，有潜力作为帕金森病治疗的辅助疗法。未来应设计大型样本研究，以确定对rTMS疗法反应良好的帕金森病特定临床特征。
