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重复经颅磁刺激对帕金森病步态障碍和认知功能障碍的影响:系统评价与荟萃分析。

Effects of repetitive transcranial magnetic stimulation on gait disorders and cognitive dysfunction in Parkinson's disease: A systematic review with meta-analysis.

机构信息

Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.

Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.

出版信息

Brain Behav. 2022 Aug;12(8):e2697. doi: 10.1002/brb3.2697. Epub 2022 Jul 21.


DOI:10.1002/brb3.2697
PMID:35862217
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9392523/
Abstract

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is acknowledged to be crucial to manage freezing of gait (FOG) and cognitive impairment for patients with Parkinson's disease (PD), but its effectiveness is unclear. OBJECTIVE: To determine the effects of rTMS on FOG and cognitive function in people with PD and to investigate potential factors that modulate the rTMS effects. METHODS: Databases searched included PubMed, Web of Science, EMBASE, and the Cochrane Library from inception to December 31, 2021. Eligible studies include a controlled randomized clinical trial of rTMS intervention for FOG and cognitive dysfunction in PD patients. The weighted mean difference (WMD) with 95% confidence intervals (CI) were calculated with fixed-effects models. The outcome of the study included gait and cognitive assessments. RESULTS: Sixteen studies with a total of 419 patients were included. Fixed-effects analysis revealed that rTMS was effective in improving freezing of gait questionnaire scores (short-term effect: WMD = -0.925, 95% CI: -1.642 to -0.209, p = .011; long-term effect: WMD = -2.120, 95% CI: -2.751 to -1.489, p = .000), 10-m walking time (short-term effect: WMD = -0.456, 95% CI: -0.793 to -0.119, p = .008; long-term effect: WMD = -0.526, 95% CI: -0.885 to -0.167, p = .004), Timed Up-and-Go scores (short-term effect: WMD = -1.064, 95% CI: -1.555 to -0.572, p = .000; long-term effect: WMD = -1.097, 95% CI: -1.422 to -0.772, p = .000), Montreal cognitive assessment (WMD = 3.714, 95% CI: 2.567 to 4.861, p = .000), and frontal assessment battery (WMD = -0.584, 95% CI: -0.934 to -0.234, p = .001). CONCLUSIONS: RTMS showed a beneficial effect on FOG and cognitive dysfunction in parkinsonism. However, the optimal rTMS protocol has not been determined and further high-quality studies are needed.

摘要

背景:重复经颅磁刺激(rTMS)被认为对管理帕金森病(PD)患者的步态冻结(FOG)和认知障碍至关重要,但其效果尚不清楚。

目的:确定 rTMS 对 PD 患者 FOG 和认知功能的影响,并探讨调节 rTMS 效果的潜在因素。

方法:检索的数据库包括 PubMed、Web of Science、EMBASE 和 Cochrane 图书馆,检索时间为 2021 年 12 月 31 日。合格的研究包括 rTMS 干预对 PD 患者 FOG 和认知功能障碍的对照随机临床试验。使用固定效应模型计算加权均数差(WMD)和 95%置信区间(CI)。该研究的结果包括步态和认知评估。

结果:纳入了 16 项共 419 名患者的研究。固定效应分析显示,rTMS 可有效改善冻结步态问卷评分(短期效应:WMD=-0.925,95%CI:-1.642 至-0.209,p=0.011;长期效应:WMD=-2.120,95%CI:-2.751 至-1.489,p=0.000)、10 米步行时间(短期效应:WMD=-0.456,95%CI:-0.793 至-0.119,p=0.008;长期效应:WMD=-0.526,95%CI:-0.885 至-0.167,p=0.004)、计时起立行走测试评分(短期效应:WMD=-1.064,95%CI:-1.555 至-0.572,p=0.000;长期效应:WMD=-1.097,95%CI:-1.422 至-0.772,p=0.000)、蒙特利尔认知评估量表(WMD=3.714,95%CI:2.567 至 4.861,p=0.000)和额叶评估电池(WMD=-0.584,95%CI:-0.934 至-0.234,p=0.001)。

结论:rTMS 对帕金森病患者的 FOG 和认知功能障碍有有益的影响。然而,尚未确定最佳 rTMS 方案,需要进一步开展高质量的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c93a/9392523/39cf3eede82f/BRB3-12-e2697-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c93a/9392523/39cf3eede82f/BRB3-12-e2697-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c93a/9392523/39cf3eede82f/BRB3-12-e2697-g001.jpg

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引用本文的文献

[1]
The effects of transcranial magnetic stimulation in motor symptoms of Parkinson's disease: an overview of systematic reviews with meta-analysis.

Neurol Sci. 2025-4-16

[2]
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[3]
Management of freezing of gait - mechanism-based practical recommendations.

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[4]
Exploring Non-invasive Brain Stimulation Effects on Physical Outcomes in People With Parkinson's Disease: An Umbrella Evidence Mapping Review With Meta-analyses.

Neurorehabil Neural Repair. 2025-4

[5]
Unveiling the efficacy of repetitive transcranial magnetic stimulation in Parkinson's disease: A comprehensive review of systematic analyses.

PLoS One. 2025-1-6

[6]
Repetitive transcranial magnetic stimulation improves cognition, depression, and walking ability in patients with Parkinson's disease: a meta-analysis.

BMC Neurol. 2024-12-24

[7]
Improving efficacy of repetitive transcranial magnetic stimulation for treatment of Parkinson disease gait disorders.

Front Hum Neurosci. 2024-8-26

[8]
Effect of different modalities of transcranial magnetic stimulation on Parkinson's patients cognitive impairment and long-term effectiveness: a systematic review and network meta-analysis.

Front Neurosci. 2024-3-1

[9]
The effects of transcranial magnetic stimulation for freezing of gait in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials.

Front Aging Neurosci. 2024-2-2

[10]
High-frequency rTMS over bilateral primary motor cortex improves freezing of gait and emotion regulation in patients with Parkinson's disease: a randomized controlled trial.

Front Aging Neurosci. 2024-1-24

本文引用的文献

[1]
Integration of Virtual Reality into Transcranial Magnetic Stimulation Improves Cognitive Function in Patients with Parkinson's Disease with Cognitive Impairment: A Proof-of-Concept Study.

J Parkinsons Dis. 2022

[2]
Parkinsonism and dementia.

J Neurol Sci. 2022-2-15

[3]
Theta Burst Magnetic Stimulation Improves Parkinson's-Related Cognitive Impairment: A Randomised Controlled Study.

Neurorehabil Neural Repair. 2021-11

[4]
Repetitive transcranial magnetic stimulation (rTMS) fails to improve cognition in patients with parkinson's disease: a Meta-analysis of randomized controlled trials.

Int J Neurosci. 2022-3

[5]
Effect of rTMS on Parkinson's cognitive function: a systematic review and meta-analysis.

BMC Neurol. 2020-10-19

[6]
Low-Frequency Repetitive Transcranial Magnetic Stimulation over Right Dorsolateral Prefrontal Cortex in Parkinson's Disease.

Parkinsons Dis. 2020-9-14

[7]
Repetitive transcranial magnetic stimulation improves Parkinson's freezing of gait via normalizing brain connectivity.

NPJ Parkinsons Dis. 2020-7-17

[8]
Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018).

Clin Neurophysiol. 2020-1-1

[9]
The effect of repetitive transcranial magnetic stimulation on cognitive impairment in Parkinson's disease with dementia: Pilot study.

Restor Neurol Neurosci. 2020

[10]
High-frequency rTMS over the supplementary motor area improves freezing of gait in Parkinson's disease: a randomized controlled trial.

Parkinsonism Relat Disord. 2019-10-11

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