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.
Brain Behav. 2022 Aug;12(8):e2697. doi: 10.1002/brb3.2697. Epub 2022 Jul 21.
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.
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。
Cochrane Database Syst Rev. 2018-3-16
Cochrane Database Syst Rev. 2018-4-13
Cochrane Database Syst Rev. 2005-7-20
Nat Rev Neurol. 2025-4-1
J Neurol Sci. 2022-2-15
Neurorehabil Neural Repair. 2021-11
BMC Neurol. 2020-10-19
Parkinsonism Relat Disord. 2019-10-11