Neurorehabilitation Department, Research Center of Neurology, Moscow, Russia -
Neurorehabilitation Department, Research Center of Neurology, Moscow, Russia.
Eur J Phys Rehabil Med. 2018 Feb;54(1):75-84. doi: 10.23736/S1973-9087.16.04433-6. Epub 2016 Dec 22.
Spasticity is associated with various diseases of the nervous system. Current treatments such as drug therapy, botulinum toxin injections, kinesitherapy, and physiotherapy are not sufficiently effective in a large number of patients. Transcranial magnetic stimulation (TMS) can be considered as an alternative method of treatment. The purpose of this article was to conduct a systematic review and meta-analysis of all available publications assessing the efficacy of repetitive TMS in treatment of spasticity.
Search for articles was conducted in databases PubMed, Willey, and Google. Keywords included "TMS", "spasticity", "TMS and spasticity", "non-invasive brain stimulation", and "non-invasive spinal cord stimulation". The difference in scores according to the Modified Ashworth Scale (MAS) for one joint before and after treatment was taken as the effect size.
We found 26 articles that examined the TMS efficacy in treatment of spasticity. Meta-analysis included 6 trials comprising 149 patients who underwent real stimulation or simulation. No statistically significant difference in the effect of real and simulated stimulation was found in stroke patients. In patients with spinal cord injury and spasticity, the mean effect size value and the 95% confidence interval were -0.80 and (-1.12, -0.49), respectively, in a group of real stimulation; in the case of simulated stimulation, these parameters were 0.15 and (-0.30, -0.00), respectively. Statistically significant differences between groups of real stimulation and simulation were demonstrated for using high-frequency repetitive TMS or iTBS mode for the M1 area of the spastic leg (P=0.0002).
According to the meta-analysis, the statistically significant effect of TMS in the form of reduced spasticity was demonstrated only for the developed due to lesions at the brain stem and spinal cord level. To clarify the amount of the antispasmodic effect of repetitive TMS at other lesion levels, in particular in patients with hemispheric stroke, further research is required.
痉挛与神经系统的各种疾病有关。目前的治疗方法，如药物治疗、肉毒杆菌毒素注射、运动疗法和物理疗法，在大量患者中效果并不十分理想。经颅磁刺激（TMS）可被视为一种替代治疗方法。本文的目的是对所有评估重复 TMS 治疗痉挛疗效的可用文献进行系统回顾和荟萃分析。
在 PubMed、Willey 和 Google 数据库中进行了文章搜索。关键词包括“TMS”、“痉挛”、“TMS 和痉挛”、“非侵入性脑刺激”和“非侵入性脊髓刺激”。治疗前后根据改良 Ashworth 量表（MAS）对一个关节的评分差异被视为效应大小。
我们发现了 26 篇研究 TMS 治疗痉挛疗效的文章。荟萃分析包括 6 项试验，共 149 名患者接受了真实刺激或模拟刺激。在中风患者中，真实刺激和模拟刺激的效果没有统计学上的显著差异。在脊髓损伤和痉挛患者中，真实刺激组的平均效应大小值和 95%置信区间分别为-0.80 和（-1.12，-0.49），模拟刺激组分别为 0.15 和（-0.30，-0.00）。真实刺激组和模拟刺激组之间的差异具有统计学意义，高频重复 TMS 或 iTBS 模式刺激痉挛腿的 M1 区（P=0.0002）。
根据荟萃分析，仅在因脑干和脊髓水平损伤而导致痉挛的患者中，TMS 在减轻痉挛方面表现出具有统计学意义的效果。为了明确重复 TMS 在其他损伤水平的抗痉挛效果量，特别是在半球性中风患者中，需要进一步研究。
