Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
Brain Stimul. 2016 Jul-Aug;9(4):475-87. doi: 10.1016/j.brs.2016.03.017. Epub 2016 Mar 30.
The short-term beneficial effects of repetitive transcranial magnetic stimulation (rTMS) on motor signs in Parkinson's disease (PD) have been addressed by previous meta-analyses while its long-term effects remain undetermined. Although deterioration of walking and upper limb function greatly affects the participation in activities and quality of life of PD sufferers, the effect of rTMS thereon has not been systematically studied.
This systematic review aimed to examine the efficacy of rTMS on improving physical function and motor signs over the short- and long-terms in people with PD.
Five electronic databases were systematically searched for English language full-text articles using relevant search terms. Only randomized placebo-controlled trials investigating the effects of rTMS in PD were considered. The primary outcomes were walking performance, upper limb function, and unified Parkinson's disease rating scale (UPDRS) section III. Trials with similar outcomes were pooled by calculating Hedges' g using random-effects model.
Twenty-two trials comprising 555 people with PD were included. Pooled estimates of effect of rTMS indicated significantly improved short-term upper limb function (Hedges' g, 0.40, P = 0.007), short-term (Hedges' g, 0.61, P = 0.03) and long-term walking performance (Hedges' g, 0.89, P = 0.03), short-term (Hedges' g, 0.31, P = 0.003) and long-term (Hedges' g, 0.54, P = 0.003) UPDRS III scores. Subgroup analyses suggest a more prominent effect for M1 stimulation. Meta-regression revealed that a greater number of total stimulation pulses were associated with more UPDRS III improvements over the long-term.
The pooled evidence suggests that rTMS improves upper limb function in the short-term, walking performance and UPDRS III in the short- and long-terms in PD sufferers. Further studies are required to develop optimal rTMS therapeutic protocols for PD.
先前的荟萃分析已经探讨了重复经颅磁刺激（rTMS）对帕金森病（PD）运动症状的短期益处，但其长期效果仍不确定。虽然行走和上肢功能的恶化极大地影响了 PD 患者的活动参与和生活质量，但 rTMS 对其的影响尚未得到系统研究。
本系统评价旨在检查 rTMS 在改善 PD 患者短期和长期身体功能和运动症状方面的疗效。
系统检索了五个英文电子数据库，使用相关检索词检索全文文章。仅纳入了研究 rTMS 对 PD 影响的随机安慰剂对照试验。主要结局是行走表现、上肢功能和统一帕金森病评定量表（UPDRS）第三部分。对具有相似结局的试验，采用随机效应模型计算 Hedges' g 进行合并。
共纳入 22 项试验，包含 555 名 PD 患者。rTMS 治疗的短期上肢功能（Hedges' g，0.40，P=0.007）、短期（Hedges' g，0.61，P=0.03）和长期行走表现（Hedges' g，0.89，P=0.03）、短期（Hedges' g，0.31，P=0.003）和长期（Hedges' g，0.54，P=0.003）UPDRS III 评分的汇总估计均表明具有显著改善。亚组分析表明 M1 刺激的效果更为显著。Meta 回归表明，长期内，总刺激脉冲数越多，UPDRS III 评分改善越大。
汇总证据表明，rTMS 可改善 PD 患者的短期上肢功能、短期和长期行走表现和 UPDRS III。需要进一步研究以制定 PD 的最佳 rTMS 治疗方案。
