School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
Clin Rehabil. 2021 Aug;35(8):1103-1116. doi: 10.1177/0269215521999554. Epub 2021 Mar 11.
To evaluate the effects and safety of repetitive transcranial magnetic stimulation (rTMS) on aphasia in stroke patients.
We searched databases from inception to January 28, 2021. Randomized control trials investigating the effects and safety of rTMS for aphasia patients after stroke were included. Study screening, data extraction, and risk of bias assessment were performed independently by two reviewers. Meta-analysis was conducted with Review Manager 5.3 software. The quality of the evidence was assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
Twenty-eight studies with 1287 patients were included. All studies were assessed at low or unclear risk of bias in one or more domains. The meta-analysis exhibited rTMS was better than sham rTMS and conventional rehabilitation in language recovery. Low-frequency rTMS showed greater improvement in language recovery except for comprehension than sham rTMS. Low-frequency and bilateral rTMS were superior to conventional rehabilitation in language recovery. High-frequency rTMS was no better than sham rTMS and conventional rehabilitation for improving aphasia. The rTMS had better effects in naming, comprehension and aphasia quotient at 20 sessions. Eleven studies reported rTMS was safe for aphasia patients after stroke. The quality of evidence for all outcomes was low or very low, and publication bias may exist.
rTMS may be relatively effective and safe for aphasia patients after stroke. However, these findings should be treated with caution due to high heterogeneity and potential biases.
评估重复经颅磁刺激（rTMS）对脑卒中后失语症患者的疗效和安全性。
我们检索了从建库至 2021 年 1 月 28 日的数据库。纳入了评估 rTMS 对脑卒中后失语症患者疗效和安全性的随机对照试验。由两名评审员独立进行研究筛选、数据提取和偏倚风险评估。使用 Review Manager 5.3 软件进行荟萃分析。通过 Grading of Recommendations Assessment, Development, and Evaluation（GRADE）评估证据质量。
共纳入 28 项研究，包含 1287 例患者。所有研究在一个或多个领域的偏倚风险均为低或不明确。荟萃分析显示，rTMS 优于假刺激 rTMS 和常规康复治疗，能改善语言恢复。低频 rTMS 在语言恢复方面优于假刺激 rTMS，但在理解方面除外。低频和双侧 rTMS 在语言恢复方面优于常规康复治疗。高频 rTMS 在改善失语症方面并不优于假刺激 rTMS 和常规康复治疗。20 次治疗后，rTMS 在命名、理解和失语症商数方面的效果更好。11 项研究报道 rTMS 对脑卒中后失语症患者是安全的。所有结局的证据质量均为低或极低，可能存在发表偏倚。
rTMS 可能对脑卒中后失语症患者相对有效且安全。但是，由于存在高度异质性和潜在偏倚，这些发现应谨慎对待。
