Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
PLoS One. 2021 Jun 17;16(6):e0251528. doi: 10.1371/journal.pone.0251528. eCollection 2021.
BACKGROUND: Migraine may lead to a negative impact on the patients' quality of life with a subsequent substantial burden to society. Therapy options for treatment and prevention of migraine have progressed over the years and repetitive transcranial magnetic stimulation (rTMS) is one of the promising non-pharmacological options. It induces and alters electric current in the brain via repetitive non-invasive brain stimulation in high frequency. In migraine patients, two common stimulation sites are the M1 cortex and dorsolateral prefrontal cortex (DLPFC). The mechanism on how rTMS exerts therapeutic effects on migraine is not fully established, but the main postulation is that the neuromodulation via high-frequency rTMS (hf-rTMS) might inhibit pain perception. However, evidence from studies has been conflicting, thus the usefulness of hf-rTMS as migraine preventive treatment is still uncertain at this moment. METHODS: This is a systematic review protocol describing essential reporting items based on the PRISMA for systematic review protocols (PRISMA-P) (Registration number: CRD42020220636). We aim to review the effectiveness, tolerability, and safety of hf-rTMS at DLPFC in randomised controlled trials (RCTs) as migraine prophylactic treatment. We will search Scopus, Cumulative Index to Nursing and Allied Health Literature Plus, PubMed, Cochrane Central Register of Controlled Trials and Biomed Central for relevant articles from randomised controlled clinical trials that used hf-rTMS applied at DLPFC for the treatment of migraine. The risk of bias will be assessed using the version 2 "Risk of bias" tool from Cochrane Handbook for Systematic Reviews of Interventions Version 6.1. We will investigate the evidence on efficacy, tolerability and safety and we will compare the outcomes between the hf-rTMS intervention and sham groups. DISCUSSION: This systematic review will further determine the efficacy, safety, and tolerability of hf-rTMS applied at DLPFC for migraine prophylaxis. It will provide additional data for health practitioners and policymakers about the usefulness of hf-rTMS for migraine preventive treatment.
背景：偏头痛可能会对患者的生活质量产生负面影响，给社会带来巨大负担。多年来，治疗和预防偏头痛的治疗选择已经取得了进展，重复经颅磁刺激（rTMS）是一种很有前途的非药物治疗选择。它通过高频重复无创脑刺激诱导和改变大脑中的电流。在偏头痛患者中，常见的两种刺激部位是 M1 皮层和背外侧前额叶皮层（DLPFC）。rTMS 如何对偏头痛产生治疗作用的机制尚未完全建立，但主要假设是高频 rTMS（hf-rTMS）的神经调节可能抑制疼痛感知。然而，来自研究的证据相互矛盾，因此目前 hf-rTMS 作为偏头痛预防治疗的有效性尚不确定。
方法：这是一个系统评价方案，根据系统评价方案的 PRISMA（PRISMA-P）（注册号：CRD42020220636）描述基本报告项目。我们旨在综述高频 rTMS 在背外侧前额叶皮层（DLPFC）治疗偏头痛预防性治疗的有效性、耐受性和安全性的随机对照试验（RCT）。我们将在 Scopus、Cumulative Index to Nursing and Allied Health Literature Plus、PubMed、Cochrane 对照试验中心注册库和 Biomed Central 中搜索使用高频 rTMS 治疗偏头痛的 DLPFC 的随机对照临床试验的相关文章。将使用 Cochrane 干预系统评价手册版本 6.1 的第 2 版“偏倚风险”工具评估偏倚风险。我们将研究疗效、耐受性和安全性方面的证据，并比较高频 rTMS 干预组和假刺激组的结果。
讨论：本系统评价将进一步确定高频 rTMS 应用于 DLPFC 预防偏头痛的疗效、安全性和耐受性。它将为卫生保健从业人员和政策制定者提供有关高频 rTMS 用于偏头痛预防性治疗的有用性的额外数据。
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