重复经颅磁刺激治疗小脑共济失调：一项系统评价和荟萃分析。
Repetitive transcranial magnetic stimulation for cerebellar ataxia: a systematic review and meta-analysis.
作者信息
Yin Lianjun, Wang Xiaoyu, Chen Lianghua, Liu Dandan, Li Haihong, Liu Zhaoxing, Huang Yong, Chen Junqi
机构信息
Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
Department of Tuina, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
出版信息
Front Neurol. 2023 Jul 7;14:1177746. doi: 10.3389/fneur.2023.1177746. eCollection 2023.
BACKGROUND
Repetitive transcranial magnetic stimulation, a non-invasive brain stimulation technique, can manage cerebellar ataxia (CA) by suppressing cerebral cortical excitability. Hence, this study aimed to summarize the efficacy and safety of rTMS for CA patients by meta-analysis.
METHODS
The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for eligible studies published till 20 May 2023. Weighted mean difference (MD) and 95% confidence intervals (CIs) were used to assess the effect of rTMS treatment. Additionally, the quality of the included studies and the risk of bias were evaluated using the Physiotherapy Evidence Database (PEDro) scale.
RESULTS
Overall, eight studies involving 278 CA patients were included in this meta-analysis. rTMS could significantly improve the Scale for the Assessment and Rating of Ataxia (SARA) (MD: -2.00; 95% CI: -3.97 to -0.02, = 0.05), International Cooperative Ataxia Rating Scale (ICARS) (MD: -3.96; 95% CI: -5.51 to -2.40, < 0.00001), Timed Up-and-Go test (TUG) (MD: -1.54; 95% CI: -2.24 to -0.84, < 0.0001), 10-m walk test (10 MWT) (MD: -2.44; 95% CI: -4.14 to -0.73, = 0.005), and Berg Balance Scale (BBS) (MD: 2.59; 95% CI: 1.15-4.03, = 0.0004) as compared to sham stimulation. Active rTMS was not significantly different from sham rTMS in changing the duration (MD: -1.29; 95% CI: -7.98 to 5.41, = 0.71). No severe adverse events were observed in both sham stimulation and active rTMS groups.
CONCLUSION
This meta-analysis provides limited evidence that rTMS may be beneficial in treating CA patients. However, these findings should be treated with caution due to the limitations of the smaller sample size and the inconsistent approach and target of rTMS treatment. Therefore, more large-scale RCTs are required to further validate our analytical findings.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=295726, identifier: CRD42022295726.
背景
重复经颅磁刺激是一种非侵入性脑刺激技术，可通过抑制大脑皮质兴奋性来治疗小脑性共济失调（CA）。因此，本研究旨在通过荟萃分析总结重复经颅磁刺激治疗CA患者的疗效和安全性。
方法
检索了PubMed、Embase、Web of Science和Cochrane图书馆数据库，查找截至2023年5月20日发表的符合条件的研究。采用加权均数差（MD）和95%置信区间（CI）评估重复经颅磁刺激治疗的效果。此外，使用物理治疗证据数据库（PEDro）量表评估纳入研究的质量和偏倚风险。
结果
总体而言，本荟萃分析纳入了8项涉及278例CA患者的研究。与假刺激相比，重复经颅磁刺激可显著改善共济失调评估与评分量表（SARA）（MD：-2.00；95%CI：-3.97至-0.02，P = 0.05）、国际协作共济失调评分量表（ICARS）（MD：-3.96；95%CI：-5.51至-2.40，P < 0.00001）、计时起立行走测试（TUG）（MD：-1.54；95%CI：-2.24至-0.84，P < 0.0001）、10米步行测试（10MWT）（MD：-2.44；95%CI：-4.14至-至-0.73，P = 0.005）和伯格平衡量表（BBS）（MD：2.59；95%CI：1.15 - 4.03，P = 0.00
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