1 Department of Radiology & Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China.
2 Lotus Biotech.com LLC., John Hopkins University-MCC, Rockville, Maryland, USA.
Clin Rehabil. 2017 Sep;31(9):1137-1153. doi: 10.1177/0269215517692386. Epub 2017 Feb 17.
The aim of this study was to evaluate the short- and long-term effects as well as other parameters of repetitive transcranial magnetic stimulation (rTMS) on upper limb motor functional recovery after stroke.
The databases of PubMed, Medline, Science Direct, Cochrane, and Embase were searched for randomized controlled studies reporting effects of rTMS on upper limb motor recovery published before October 30, 2016.
The short- and long-term mean effect sizes as well as the effect size of rTMS frequency of pulse, post-stroke onset, and theta burst stimulation patterns were summarized by calculating the standardized mean difference (SMD) and the 95% confidence interval using fixed/random effect models as appropriate.
Thirty-four studies with 904 participants were included in this systematic review. Pooled estimates show that rTMS significantly improved short-term (SMD, 0.43; P < 0.001) and long-term (SMD, 0.49; P < 0.001) manual dexterity. More pronounced effects were found for rTMS administered in the acute phase of stroke (SMD, 0.69), subcortical stroke (SMD, 0.66), 5-session rTMS treatment (SMD, 0.67) and intermittent theta burst stimulation (SMD, 0.60). Only three studies reported mild adverse events such as headache and increased anxiety .
Five-session rTMS treatment could best improve stroke-induced upper limb dyskinesia acutely and in a long-lasting manner. Intermittent theta burst stimulation is more beneficial than continuous theta burst stimulation. rTMS applied in the acute phase of stroke is more effective than rTMS applied in the chronic phase. Subcortical lesion benefit more from rTMS than other lesion site.
本研究旨在评估重复经颅磁刺激（rTMS）对脑卒中后上肢运动功能恢复的短期和长期效果及其他参数。
检索 PubMed、Medline、Science Direct、Cochrane 和 Embase 数据库，以获取截至 2016 年 10 月 30 日发表的关于 rTMS 对上肢运动恢复影响的随机对照研究。
采用固定/随机效应模型，计算标准化均数差（SMD）和 95%置信区间，以总结 rTMS 频率脉冲、脑卒中后发病时间和 theta 爆发刺激模式的短期和长期平均效应量以及效应量。
本系统评价共纳入 34 项研究，904 例患者。汇总估计表明，rTMS 可显著改善短期（SMD，0.43；P<0.001）和长期（SMD，0.49；P<0.001）手灵巧度。rTMS 治疗急性脑卒中（SMD，0.69）、皮质下脑卒中（SMD，0.66）、5 次 rTMS 治疗（SMD，0.67）和间歇性 theta 爆发刺激（SMD，0.60）的效果更为明显。仅 3 项研究报告了轻度不良反应，如头痛和焦虑增加。
5 次 rTMS 治疗可在急性和长期内最好地改善脑卒中引起的上肢运动障碍。间歇性 theta 爆发刺激比连续 theta 爆发刺激更有效。rTMS 在脑卒中急性期应用比在慢性期应用更有效。皮质下病变比其他病变部位更受益于 rTMS。
