Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Mult Scler Relat Disord. 2019 Nov;36:101375. doi: 10.1016/j.msard.2019.08.017. Epub 2019 Aug 28.
To investigate the efficacy and safety of non-invasive brain stimulation for fatigue in multiple sclerosis patients.
We searched MEDLINE, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, and Wanfang databases up to October 25, 2018 (PROSPERO registration number: CRD42018112823). Randomized or pseudo-randomized, sham-controlled clinical trials evaluating the effect of non-invasive brain stimulation (NIBS) such as transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), transcranial random noise stimulation (tRNS), transcranial alternating current stimulation (tACS), cranial electrotherapy stimulation, and reduced impedance non-invasive cortical electrostimulation were included. Two authors independently performed data extraction and risk of bias assessment according to Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The primary outcome was fatigue scores before and after stimulation and the secondary outcome was adverse events.
Data from cross-over and parallel group studies were pooled using a generic inverse-variance approach. A total of 14 studies (11 for tDCS, 2 for TMS, and 1 for tRNS) recruiting 207 patients were included in the systematic review and meta-analysis. No eligible tACS, cranial electrotherapy stimulation or reduced impedance non-invasive cortical electrostimulation studies were found. Short-term and long-term treatment effects were significant for tDCS, whereas TMS and tRNS were not superior to sham stimulation. The available evidence supported the effectiveness of the 1.5 mA subgroup and bilateral S1 subgroup of tDCS. Adverse events were minor and transient but comparable between real and sham stimulation.
tDCS is a safe and effective treatment for fatigue in MS patients. However, further studies are required to confirm our results in a large-scale population and to investigate the effectiveness of other NIBS subtypes.
研究非侵入性脑刺激治疗多发性硬化症患者疲劳的疗效和安全性。
我们检索了 MEDLINE、Embase、Web of Science、Cochrane 图书馆、中国知网和万方数据库，检索时间截至 2018 年 10 月 25 日（PROSPERO 注册号：CRD42018112823）。纳入评估非侵入性脑刺激（NIBS），如经颅直流电刺激（tDCS）、经颅磁刺激（TMS）、经颅随机噪声刺激（tRNS）、经颅交流电刺激（tACS）、颅电刺激和降低阻抗非侵入性皮层电刺激等治疗效果的随机或伪随机、假刺激对照临床试验。两名作者根据 Cochrane 干预系统评价手册 5.0.1 独立进行数据提取和偏倚风险评估。主要结局是刺激前后的疲劳评分，次要结局是不良事件。
采用通用倒数方差法对交叉和平行组研究的数据进行合并。系统评价和荟萃分析共纳入了 14 项研究（11 项 tDCS，2 项 TMS，1 项 tRNS），共招募了 207 名患者。tACS、颅电刺激或降低阻抗非侵入性皮层电刺激的研究均未纳入。tDCS 的短期和长期治疗效果显著，而 TMS 和 tRNS 并不优于假刺激。现有证据支持 1.5 mA 亚组和双侧 S1 亚组 tDCS 的有效性。不良事件轻微且短暂，但与真刺激和假刺激之间无差异。
tDCS 是治疗多发性硬化症患者疲劳的一种安全有效的方法。然而，还需要进一步的研究来在更大规模的人群中证实我们的结果，并研究其他 NIBS 亚型的有效性。
