重复经颅磁刺激对中风患者上肢和手指功能的影响：一项随机对照试验的系统评价和荟萃分析
Effects of repetitive transcranial magnetic stimulation on upper-limb and finger function in stroke patients: A systematic review and meta-analysis of randomized controlled trials.
作者信息
Chen Gengbin, Lin Tuo, Wu Manfeng, Cai Guiyuan, Ding Qian, Xu Jiayue, Li Wanqi, Wu Cheng, Chen Hongying, Lan Yue
机构信息
Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Postgraduate Research Institute, Guangzhou Sport University, Guangzhou, China.
出版信息
Front Neurol. 2022 Jul 29;13:940467. doi: 10.3389/fneur.2022.940467. eCollection 2022.
BACKGROUND
Repetitive transcranial magnetic stimulation (rTMS) is a promising intervention for stroke rehabilitation. Several studies have demonstrated the effectiveness of rTMS in restoring motor function. This meta-analysis aimed to summarize the current evidence of the effect of rTMS in improving upper limb function and fine motor recovery in stroke patients.
METHODS
Three online databases (Web of Science, PubMed, and Embase) were searched for relevant randomized controlled trials. A total of 45 studies (combined = 2064) were included. Random effects model was used for meta-analysis and effect size was reported as standardized mean difference (SMD).
RESULTS
rTMS was effective in improving fine motor function in stroke patients (SMD, 0.38; 95% CI 0.19-0.58; = 0). On subgroup analyses, for post-stroke functional improvement of the upper extremity, bilateral hemisphere stimulation was more effective than unilateral stimulation during the acute phase of stroke, and a regimen of 20 rTMS sessions produced greater improvement than <20 sessions. In the subacute phase of stroke, affected hemispheric stimulation with a 40-session rTMS regimen was superior to unaffected hemispheric stimulation or bilateral hemispheric stimulation with <40 sessions. Unaffected site stimulation with a 10-session rTMS regimen produced significant improvement in the chronic phase compared to affected side stimulation and bilateral stimulation with >10 rTMS sessions. For the rTMS stimulation method, both TBS and rTMS were found to be significantly more effective in the acute phase of stroke, but TBS was more effective than rTMS. However, rTMS was found to be more effective than TBS stimulation in patients in the subacute and chronic phases of stroke. rTMS significantly improved upper limb and fine function in the short term (0-1-month post-intervention) and medium term (2-5 months), but not for upper limb function in the long term (6 months+). The results should be interpreted with caution due to significant heterogeneity.
CONCLUSIONS
This updated meta-analysis provides robust evidence of the efficacy of rTMS treatment in improving upper extremity and fine function during various phases of stroke.
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2022-5-0121/, identifier: INPLASY202250121.
背景
重复经颅磁刺激（rTMS）是一种很有前景的中风康复干预措施。多项研究已证明rTMS在恢复运动功能方面的有效性。本荟萃分析旨在总结当前关于rTMS对改善中风患者上肢功能和精细运动恢复效果的证据。
方法
检索了三个在线数据库（科学网、PubMed和Embase）以查找相关随机对照试验。共纳入45项研究（合并样本量 = 2064）。采用随机效应模型进行荟萃分析，效应量以标准化均数差（SMD）表示。
结果
rTMS对改善中风患者的精细运动功能有效（SMD，0.38；95%置信区间0.19 - 0.58；P = 0）。亚组分析显示，对于中风后上肢功能改善，在中风急性期，双侧半球刺激比单侧刺激更有效，20次rTMS治疗方案比少于20次的方案产生更大改善。在中风亚急性期，40次rTMS治疗方案的患侧半球刺激优于未患侧半球刺激或少于40次的双侧半球刺激。在中风慢性期，10次rTMS治疗方案的未患侧部位刺激与患侧刺激及超过10次的双侧刺激相比产生显著改善。对于rTMS刺激方法，在中风急性期，theta爆发刺激（TBS）和rTMS均被发现显著更有效，但TBS比rTMS更有效。然而，在中风亚急性期和慢性期患者中，rTMS被发现比TBS刺激更有效。rTMS在短期（干预后0 - 1个月）和中期（2 - 5个月）显著改善上肢和精细功能，但对长期（6个月及以上）上肢功能无改善。由于存在显著异质性，结果应谨慎解读。
结论
这项更新的荟萃分析提供了有力证据，证明rTMS治疗在中风各阶段改善上肢和精细功能方面的有效性。
系统评价注册
https://inplasy.com/inplasy-2022-5-0121/，标识符：INPLASY202250121。
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