Department of Rehabilitation, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eiveniu Str. 2, LT-50161 Kaunas, Lithuania
Department of Rehabilitation, Lithuanian University of Health Sciences, Mickeviciaus Str. 7, LT-44307 Kaunas, Lithuania
Medicina (Kaunas). 2021 Nov 7;57(11):1215. doi: 10.3390/medicina57111215.
Repetitive transcranial magnetic stimulation (rTMS) is being widely used for treating upper extremity paresis after stroke, however, evidence of applying high-frequency rTMS (HF-rTMS) on the ipsilesional hemisphere for upper extremity motor recovery remains limited. This systematic review aimed to investigate the effect of high-frequency repetitive transcranial magnetic stimulation for upper extremity motor function recovery after a first-time ischaemic stroke. This systematic review was prepared according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive literature search was performed to identify all studies published before 12 February 2021. The search was performed on the following databases: PubMed, Ovid, The Cochrane Library. A total of 6440 studies were found in the databases and four trials were included in the review. Three of the studies were randomized control trials (RCT), and one was a pseudo-RCT. Three of the studies showed good methodological quality and one study was rated as excellent. Fugl-Meyer Assessment (FMA) was performed in three out of four studies and the score significantly increased in the HF-rTMS treatment group compared with sham stimulation in all trials. Other measures used in the studies were handgrip strength, shoulder abduction, Motricity Index, Wolf Motor Function Test (WMFT), and Box and Block, although these tests did not show unanimous results. Overall, all four studies conveyed significantly better results in at least one test that was performed for hand motor function evaluation in a 10 Hz stimulation group while none of the tests showed any advantage for sham stimulation groups. Two studies reported headache as an adverse event (six patients in total). The overall results showed that HF-rTMS may increase impaired upper extremity motor function better than sham stimulation in stroke patients.
重复经颅磁刺激（rTMS）被广泛应用于治疗脑卒中后的上肢瘫痪，但高频 rTMS（HF-rTMS）应用于病变半球以促进上肢运动功能恢复的证据仍然有限。本系统评价旨在探讨高频重复经颅磁刺激对首次缺血性脑卒中后上肢运动功能恢复的影响。本系统评价按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行准备。进行了全面的文献检索，以确定截至 2021 年 2 月 12 日之前发表的所有研究。检索在以下数据库中进行：PubMed、Ovid、The Cochrane Library。在数据库中发现了 6440 项研究，其中有 4 项试验被纳入综述。其中 3 项为随机对照试验（RCT），1 项为伪 RCT。3 项研究具有良好的方法学质量，1 项研究被评为优秀。4 项研究中有 3 项进行了 Fugl-Meyer 评估（FMA），在所有试验中，HF-rTMS 治疗组的评分明显高于假刺激组。研究中还使用了其他措施，如手握力、肩关节外展、运动指数、Wolf 运动功能测试（WMFT）和方块和木块，但这些测试没有得出一致的结果。总的来说，在接受 10Hz 刺激组中，所有 4 项研究都至少有一项手部运动功能评估的测试结果明显更好，而假刺激组在任何测试中都没有显示出任何优势。有 2 项研究报告头痛是一种不良事件（共有 6 名患者）。总体结果表明，HF-rTMS 可能比假刺激更能改善脑卒中患者受损的上肢运动功能。
