Department of Neurology, The First People's Hospital of Longquanyi District Chengdu, Longquanyi District, Chengdu, China.
Department of Hematology, The Third People's Hospital of Chengdu, Qingyang District, Chengdu, China.
Braz J Med Biol Res. 2023 May 29;56:e12708. doi: 10.1590/1414-431X2023e12708. eCollection 2023.
Pilot trials have suggested that repetitive transcranial magnetic stimulation (rTMS) may reduce limb spasticity in multiple sclerosis (MS). We carried out the current meta-analysis to synthesize currently available evidence regarding such correlation. Up to November 2022, five international electronic databases (Cochrane CENTRAL, PubMed, Embase, Web of Science, and CINAHL) and four Chinese electronic databases (CBM, CNKI, WanFang Data, and VIP) were systematically searched to identify randomized trials comparing active rTMS and sham stimulation in patients with MS-related spasticity. Two reviewers independently selected studies and extracted data on study design, quality, clinical outcomes, and time points measured. The primary outcome was clinical spasticity relief after intervention. Secondary outcomes included spasticity at the follow-up visit 2 weeks later and post-treatment fatigue. Of 831 titles found, we included 8 studies (181 participants) in the quantitative analysis. Pooled analyses showed that rTMS therapy was associated with significant spasticity relief in the early post-intervention period [standardized mean differences (SMD): -0.67; 95%CI: -1.12 to -0.21], but there was insufficient evidence for rTMS in reducing spasticity at the follow-up visit 2 weeks later (SMD: -0.17; 95%CI: -0.52 to 0.17) and fatigue (SMD: -0.26; 95%CI: -0.84 to 0.31). This evidence supports the recommendations to treat MS-related spasticity with rTMS, but underlines the need for further large randomized trials.
初步研究表明，重复经颅磁刺激（rTMS）可能会降低多发性硬化症（MS）患者的肢体痉挛。我们进行了此次荟萃分析，以综合目前关于这种相关性的所有证据。截至 2022 年 11 月，我们系统性地检索了五个国际电子数据库（Cochrane 中心、PubMed、Embase、Web of Science 和 CINAHL）和四个中文电子数据库（CBM、CNKI、万方数据和 VIP），以确定比较 MS 相关痉挛患者接受 rTMS 与假刺激的随机试验。两名审查员独立筛选研究并提取研究设计、质量、临床结局和测量时间点的数据。主要结局是干预后临床痉挛缓解。次要结局包括 2 周后随访时的痉挛和治疗后疲劳。在 831 个标题中，我们纳入了 8 项研究（181 名参与者）进行定量分析。汇总分析表明，rTMS 治疗与干预后早期痉挛显著缓解相关[标准化均数差（SMD）：-0.67；95%CI：-1.12 至-0.21]，但 rTMS 在降低 2 周后随访时的痉挛（SMD：-0.17；95%CI：-0.52 至 0.17）和疲劳（SMD：-0.26；95%CI：-0.84 至 0.31）方面的证据不足。这一证据支持 rTMS 治疗 MS 相关痉挛的建议，但强调需要进一步进行大型随机试验。
