不同无创脑刺激疗法对中风后整体认知功能、注意力、记忆力和执行功能恢复的比较疗效：一项随机对照试验的网状Meta分析
Comparative efficacy of different noninvasive brain stimulation therapies for recovery of global cognitive function, attention, memory, and executive function after stroke: a network meta-analysis of randomized controlled trials.
作者信息
Wang Yao, Liu Wan, Chen Jiu, Bai Jianling, Yu Hao, Ma Hongxia, Rao Jiang, Xu Guangxu
机构信息
Department of Rehabilitation Medicine, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
出版信息
Ther Adv Chronic Dis. 2023 Jun 10;14:20406223231168754. doi: 10.1177/20406223231168754. eCollection 2023.
BACKGROUND
Which noninvasive brain stimulation (NIBS) treatment - transcranial direct current stimulation (tDCS) or transcranial magnetic stimulation (TMS) - is more beneficial for stroke patients' cognitive rehabilitation is still up for debate.
OBJECTIVES
Our goal is to provide an overview of the research on the effectiveness and safety of various NIBS protocols.
DESIGN
Systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs).
METHODS
This NMA compared any active NIBS sham stimulation in adult stroke survivors to enhance cognitive function, with a focus on global cognitive function (GCF), attention, memory, and executive function (EF) using the databases MEDLINE, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. The NMA statistical approach was built on a frequency framework. The effect size was estimated by the standardized mean difference (SMD) and a 95% confidence interval (CI). We compiled a relative ranking of the competing interventions based on their surface under the cumulative ranking curve (SUCRA).
RESULTS
NMA showed that high-frequency repeated TMS (HF-rTMS) improved GCF compared with sham stimulation (SMD = 1.95; 95% CI: 0.47-3.43), while dual-tDCS improved memory performance sham stimulation significantly (SMD = 6.38; 95% CI: 3.51-9.25). However, various NIBS stimulation protocols revealed no significant impact on enhancing attention, executive function, or activities of daily living. There was no significant difference between the active stimulation protocols for TMS and tDCS and sham stimulation in terms of safety. Subgroup analysis demonstrated an effect favoring activation site of the left dorsolateral prefrontal cortex (DLPFC) (SUCRA = 89.1) for enhancing GCF and bilateral DLPFC (SUCRA = 99.9) stimulation for enhancing memory performance.
CONCLUSION
The HF-rTMS over the left DLPFC appears to be the most promising NIBS therapeutic option for improving global cognitive performance after stroke, according to a comparison of numerous NIBS protocols. Furthermore, for patients with post-stroke memory impairment, dual-tDCS over bilateral DLPFC may be more advantageous than other NIBS protocols. Both tDCS and TMS are reasonably safe.
REGISTRATION
PROSPERO ID: CRD42022304865.
背景
哪种非侵入性脑刺激（NIBS）治疗——经颅直流电刺激（tDCS）还是经颅磁刺激（TMS）——对中风患者的认知康复更有益仍存在争议。
目的
我们的目标是概述各种NIBS方案有效性和安全性的研究。
设计
对随机对照试验（RCT）进行系统评价和网络荟萃分析（NMA）。
方法
本NMA比较了成年中风幸存者中任何活性NIBS与假刺激对增强认知功能的影响，重点关注使用MEDLINE、Embase、Cochrane图书馆、科学网和ClinicalTrials.gov数据库的整体认知功能（GCF）、注意力、记忆力和执行功能（EF）。NMA统计方法基于频率框架构建。效应大小通过标准化均数差（SMD）和95%置信区间（CI）估计。我们根据累积排名曲线下的面积（SUCRA）对竞争干预措施进行了相对排名。
结果
NMA显示，与假刺激相比，高频重复TMS（HF-rTMS）改善了GCF（SMD = 1.95；95%CI：0.47 - 3.43），而双部位tDCS显著改善了记忆力 假刺激（SMD = 6.38；95%CI：3.51 - 9.25）。然而，各种NIBS刺激方案对增强注意力、执行功能或日常生活活动没有显著影响。在安全性方面，TMS和tDCS的活性刺激方案与假刺激之间没有显著差异。亚组分析表明，对于增强GCF，有利于左侧背外侧前额叶皮质（DLPFC）激活部位（SUCRA = 89.1），对于增强记忆力，有利于双侧DLPFC刺激（SUCRA = 99.9）。
结论
根据众多NIBS方案的比较，左侧DLPFC上的HF-rTMS似乎是中风后改善整体认知表现最有前景的NIBS治疗选择。此外，对于中风后记忆障碍患者，双侧DLPFC上的双部位tDCS可能比其他NIBS方案更具优势。tDCS和TMS都相当安全。
注册
PROSPERO编号：CRD42022304865。
Zotero 插件