Department of Rehabilitation, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China.
Neural Plast. 2022 Jul 30;2022:2036736. doi: 10.1155/2022/2036736. eCollection 2022.
Neuropathic pain and neuropsychiatric symptoms are common complications reported by the traumatic brain injury (TBI) population. Although a growing body of research has indicated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for the management of neurological and psychiatric disorders, little evidence has been presented to support the effects of rTMS on neuropathic pain and neuropsychiatric symptoms in patients with TBI in all age groups. In addition, a better understanding of the potential factors that might influence the therapeutic effect of rTMS is necessary. The objective of this preregistered systematic review and meta-analysis was to quantify the effects of rTMS on physical and psychological symptoms in individuals with TBI. We systematically searched six databases for randomized controlled trials (RCTs) of rTMS in TBI patients reporting pain and neuropsychiatric outcomes published until March 20, 2022. The mean difference (MD) with 95% confidence intervals (CIs) was estimated separately for outcomes to understand the mean effect size. Twelve RCTs with 276 TBI patients were ultimately selected from 1605 records for systematic review, and 11 of the studies were included in the meta-analysis. Overall, five of the included studies showed a low risk of bias. The effects of rTMS on neuropathic pain were statistically significant (MD = -1.00, 95% CI -1.76 to -0.25, = 0.009), with high heterogeneity ( = 76%). A significant advantage of 1 Hz rTMS over the right dorsolateral prefrontal cortex (DLPFC) in improving depression (MD = -6.52, 95% CI -11.58 to -1.46, = 0.01) was shown, and a significant improvement was noted in the Rivermead Post-Concussion Symptoms Questionnaire-13 (RPQ-13) scores of mild TBI patients after rTMS (MD = -5.87, 95% CI -10.63 to -1.11, = 0.02). However, no significance was found in cognition measurement. No major adverse events related to rTMS were reported. Moderate evidence suggests that rTMS can effectively and safely improve neuropathic pain, while its effectiveness on depression, postconcussion symptoms, and cognition is limited. More trials with a larger number of participants are needed to draw firm conclusions. This trial is registered with PROSPERO (PROSPERO registration number: CRD42021242364.
神经病理性疼痛和神经精神症状是创伤性脑损伤 (TBI) 患者常见的并发症。尽管越来越多的研究表明重复经颅磁刺激 (rTMS) 对治疗神经和精神疾病有效，但几乎没有证据表明 rTMS 对所有年龄段 TBI 患者的神经病理性疼痛和神经精神症状有影响。此外，需要更好地了解可能影响 rTMS 治疗效果的潜在因素。本预先注册的系统评价和荟萃分析的目的是量化 rTMS 对 TBI 个体的身体和心理症状的影响。我们系统地检索了六个数据库，以寻找报告疼痛和神经精神结局的 TBI 患者 rTMS 的随机对照试验 (RCT)，检索截至 2022 年 3 月 20 日。分别估计结局的均数差值 (MD) 和 95%置信区间 (CI)，以了解平均效应量。从 1605 条记录中进行系统评价，最终选择了 12 项 RCT 共 276 例 TBI 患者，其中 11 项研究纳入荟萃分析。总体而言，纳入的五项研究显示出低偏倚风险。rTMS 对神经病理性疼痛的影响具有统计学意义 (MD = -1.00，95%CI -1.76 至 -0.25， = 0.009)，异质性高 ( = 76%)。与右背外侧前额叶皮质 (DLPFC) 相比，1 Hz rTMS 显著改善抑郁 (MD = -6.52，95%CI -11.58 至 -1.46， = 0.01)，且 rTMS 可显著改善轻度 TBI 患者的 Rivermead 脑震荡后症状问卷-13 (RPQ-13) 评分 (MD = -5.87，95%CI -10.63 至 -1.11， = 0.02)。然而，认知测量未见显著变化。未报告与 rTMS 相关的重大不良事件。有中等证据表明，rTMS 可以有效且安全地改善神经病理性疼痛，但其对抑郁、脑震荡后症状和认知的效果有限。需要更多具有更大样本量的试验来得出更可靠的结论。本试验已在 PROSPERO 注册 (PROSPERO 注册号：CRD42021242364)。
