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重复经颅磁刺激治疗帕金森病运动障碍的 Meta 分析。

Repetitive transcranial magnetic stimulation therapy for motor recovery in Parkinson's disease: A Meta-analysis.

机构信息

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.

Chengdu 363 Hospital of Southwest Medical University, Chengdu, China.

出版信息

Brain Behav. 2018 Nov;8(11):e01132. doi: 10.1002/brb3.1132. Epub 2018 Sep 28.


DOI:10.1002/brb3.1132
PMID:30264518
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6236247/
Abstract

INTRODUCTION: Therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on motor recovery of Parkinson's disease (PD) have been reported; however, the protocols of these studies varied greatly. The aim of this meta-analysis was to evaluate the optimal rTMS parameters for motor recovery of PD. METHODS: Electronic databases were searched for studies investigating the therapeutic effects of rTMS on motor function in patients with PD. The section III of the Unified Parkinson's Disease Rating Scale (UPDRS) was extracted as the primary outcome, and the standardized mean difference (SMD) with 95% confidence interval (CI) was calculated. RESULTS: Twenty-three studies with a total of 646 participants were included. The pooled estimates of rTMS revealed significant short-term (SMD, 0.37; p < 0.00001) and long-term (SMD, 0.39; p = 0.005) effects on motor function improvement of PD. Subgroup analysis observed that high-frequency rTMS (HF-rTMS) was significant in improving motor function (SMD, 0.48; p < 0.00001), but low-frequency rTMS (LF-rTMS) was not. In particular, when HF-rTMS targeted over the primary motor cortex (M1), in which the bilateral M1 revealed a larger effect size than unilateral M1. Compared to single-session, multi-session of HF-rTMS over the M1 showed significant effect size. In addition, HF-rTMS over the M1 with a total of 18,000-20,000 stimulation pulses yielded more significant effects (SMD, 0.97; p = 0.01) than other dosages. CONCLUSIONS: In conclusion, multi-session of HF-rTMS over the M1 (especially bilateral M1) with a total of 18,000-20,000 pulses appears to be the optimal parameters for motor improvement of PD.

摘要

介绍:重复经颅磁刺激(rTMS)对帕金森病(PD)运动功能恢复的治疗效果已有报道,但这些研究的方案差异很大。本荟萃分析旨在评估 rTMS 治疗 PD 运动功能恢复的最佳参数。

方法:电子数据库检索了研究 rTMS 对 PD 患者运动功能治疗效果的研究。提取统一帕金森病评定量表(UPDRS)第 III 部分作为主要结局,计算标准化均数差(SMD)及其 95%置信区间(CI)。

结果:共纳入 23 项研究,总计 646 名参与者。rTMS 的汇总估计显示,短期(SMD,0.37;p<0.00001)和长期(SMD,0.39;p=0.005)均对 PD 运动功能改善有显著效果。亚组分析发现高频 rTMS(HF-rTMS)对改善运动功能(SMD,0.48;p<0.00001)有显著作用,而低频 rTMS(LF-rTMS)则无显著作用。具体来说,当 HF-rTMS 靶向初级运动皮层(M1)时,双侧 M1 的效果比单侧 M1 更大。与单次治疗相比,M1 上的多次 HF-rTMS 治疗具有更大的效果。此外,M1 上的 18000-20000 次 HF-rTMS 总刺激脉冲数产生的效果更显著(SMD,0.97;p=0.01)。

结论:总之,M1 上多次(特别是双侧 M1)HF-rTMS 治疗,总刺激脉冲数为 18000-20000 次,似乎是 PD 运动功能改善的最佳参数。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/84ed/6236247/72d9f7bcd218/BRB3-8-e01132-g010.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/84ed/6236247/eef23ac537a6/BRB3-8-e01132-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/84ed/6236247/4782ba915901/BRB3-8-e01132-g008.jpg
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本文引用的文献

[1]
Repetitive Deep TMS for Parkinson Disease: A 3-Month Double-Blind, Randomized Sham-Controlled Study.

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The optimal stimulation site for high-frequency repetitive transcranial magnetic stimulation in Parkinson's disease: A double-blind crossover pilot study.

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