Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Neuromodulation. 2021 Jul;24(5):803-812. doi: 10.1111/ner.13319. Epub 2020 Nov 12.
Post-concussive symptoms (PCSs) are common, disabling, and challenging to manage. Evolving models of concussion pathophysiology suggest evidence of brain network dysfunction that may be amenable to neuromodulation. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential novel treatment option for PCSs.
To systematically review rTMS trials for the treatment of symptoms following concussion/mild traumatic brain injury (mTBI).
We conducted a systematic review of Pubmed/Medline, Embase, and PsychINFO databases were searched up to May 19, 2020. Studies were included if they were prospective rTMS treatment studies of patients with mTBI/concussion. Variables including patient demographics, study design, rTMS protocol parameters, primary outcome measures, and efficacy data were extracted and qualitatively synthesized. rTMS methodology and study quality were also evaluated.
Of the 342 studies identified, 11 met eligibility criteria and were included for synthesis. Forty-one percent of patients were female and age ranged from 18 to 65 (average age = 38.5 years). Post-concussive depression (seven studies) and headache (four studies) were the most commonly investigated symptoms. The majority of trials were sham-controlled with randomized control trial (RCT) designs, but all were small pilot samples (n < 30). Methodological heterogeneity and a low number of identified trials precluded quantitative meta-analysis. Regarding rTMS for post-concussive depression, positive results were found in two out of four studies with depression as a primary outcome, and all three studies that assessed depression as a secondary outcome. All four rTMS studies for post-concussive headache reported positive results.
rTMS for the treatment of concussion/mTBI shows promising preliminary results for post-concussive depression and headache, symptoms that otherwise have limited effective treatment options. More studies with larger sample sizes are needed to further establish potential efficacy.
脑震荡后症状（PCSs）很常见，且具有致残性，难以治疗。不断发展的脑震荡病理生理学模型表明，大脑网络功能障碍存在证据，这可能适合神经调节。重复经颅磁刺激（rTMS）已成为 PCSs 的一种潜在新型治疗选择。
系统评价 rTMS 治疗脑震荡/轻度创伤性脑损伤（mTBI）后症状的临床试验。
我们对 Pubmed/Medline、Embase 和 PsychINFO 数据库进行了系统检索，检索截至 2020 年 5 月 19 日。如果研究为前瞻性 rTMS 治疗 mTBI/脑震荡患者的研究，则纳入研究。提取了包括患者人口统计学、研究设计、rTMS 方案参数、主要结局测量和疗效数据等变量，并进行了定性综合。还评估了 rTMS 方法学和研究质量。
在 342 项研究中，有 11 项符合纳入标准并进行了综合分析。41%的患者为女性，年龄在 18 至 65 岁之间（平均年龄为 38.5 岁）。脑震荡后抑郁（7 项研究）和头痛（4 项研究）是最常研究的症状。大多数试验为假刺激对照、随机对照试验（RCT）设计，但均为小样本（n<30）的试点研究。方法学的异质性和研究数量的不足，排除了定量荟萃分析。对于 rTMS 治疗脑震荡后抑郁，有两项研究（以抑郁为主要结局）和三项研究（以抑郁为次要结局）发现阳性结果。四项脑震荡后头痛的 rTMS 研究均报告阳性结果。
rTMS 治疗脑震荡/mTBI 对脑震荡后抑郁和头痛有初步的疗效，这些症状否则治疗选择有限。需要更多的大样本量研究进一步确定潜在疗效。
