Qiu Youjia, Yin Ziqian, Wang Menghan, Duan Aojie, Xie Minjia, Wu Jiang, Wang Zhong, Chen Gang
Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China.
Suzhou Medical College of Soochow University, Suzhou, China.
Front Neurosci. 2023 Jul 26;17:1212640. doi: 10.3389/fnins.2023.1212640. eCollection 2023.
Parkinson's disease (PD) is a neurodegenerative disorder defined by progressive motor and non-motor symptoms. Currently, the pro-cognitive effects of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are well-supported in previous literatures. However, controversy surrounding the optimal therapeutic target for motor symptom improvement remains.
This network meta-analysis (NMA) was conducted to comprehensively evaluate the optimal strategy to use rTMS and tDCS to improve motor symptoms in PD.
We searched PubMed, Embase, and Cochrane electronic databases for eligible randomized controlled studies (RCTs). The primary outcome was the changes of Unified Parkinson's Disease Rating Scale (UPDRS) part III score, the secondary outcomes were Time Up and Go Test (TUGT) time, and Freezing of Gait Questionnaire (FOGQ) score. The safety outcome was indicated by device-related adverse events (AEs).
We enrolled 28 studies that investigated various strategies, including high-frequency rTMS (HFrTMS), low-frequency rTMS (LFrTMS), anodal tDCS (AtDCS), AtDCS_ cathode tDCS (CtDCS), HFrTMS_LFrTMS, and Sham control groups. Both HFrTMS (short-term: mean difference (MD) -5.21, 95% credible interval (CrI) -9.26 to -1.23, long-term: MD -4.74, 95% CrI -6.45 to -3.05), and LFrTMS (long-term: MD -4.83, 95% CrI -6.42 to -3.26) were effective in improving UPDRS-III score compared with Sham stimulation. For TUGT time, HFrTMS (short-term: MD -2.04, 95% CrI -3.26 to -0.8, long-term: MD -2.66, 95% CrI -3.55 to -1.77), and AtDCS (short-term: MD -0.8, 95% CrI -1.26 to -0.34, long-term: MD -0.69, 95% CrI -1.31 to -0.08) produced a significant difference compared to Sham stimulation. However, no statistical difference was found in FOGQ score among the various groups. According to the surface under curve ranking area, HFrTMS ranked first in short-term UPDRS-III score (0.77), short-term (0.82), and long-term (0.84) TUGT time, and short-term FOGQ score (0.73). With respect to the safety outcomes, all strategies indicated few and self-limiting AEs.
HFrTMS may be the optimal non-invasive brain stimulation (NIBS) intervention to improve motor function in patients with PD while NIBS has generally been well tolerated. However, further studies focusing on the clinical outcomes resulting from the different combined schedules of tDCS and rTMS are required.
https://inplasy.com/inplasy-2023-4-0087/, identifier: 202340087.
帕金森病（PD）是一种由进行性运动和非运动症状所定义的神经退行性疾病。目前，经颅直流电刺激（tDCS）和重复经颅磁刺激（rTMS）的促认知作用在以往文献中得到了充分支持。然而，关于改善运动症状的最佳治疗靶点仍存在争议。
进行这项网络荟萃分析（NMA）以全面评估使用rTMS和tDCS改善PD患者运动症状的最佳策略。
我们在PubMed、Embase和Cochrane电子数据库中检索符合条件的随机对照试验（RCT）。主要结局是统一帕金森病评定量表（UPDRS）第三部分评分的变化，次要结局是计时起立行走测试（TUGT）时间和冻结步态问卷（FOGQ）评分。安全性结局通过与设备相关的不良事件（AE）来表示。
我们纳入了28项研究，这些研究调查了各种策略，包括高频rTMS（HFrTMS）、低频rTMS（LFrTMS）、阳极tDCS（AtDCS）、AtDCS_阴极tDCS（CtDCS）、HFrTMS_LFrTMS以及假刺激对照组。与假刺激相比，HFrTMS（短期：平均差（MD）-5.21，95%可信区间（CrI）-9.26至-1.23，长期：MD -4.74，95% CrI -6.45至-3.05）和LFrTMS（长期：MD -4.83，95% CrI -6.42至-3.26）在改善UPDRS-III评分方面均有效。对于TUGT时间，与假刺激相比，HFrTMS（短期：MD -2.04，95% CrI -3.26至-0.8，长期：MD -2.66，95% CrI -3.55至-1.77）和AtDCS（短期：MD -0.8，95% CrI -1.26至-0.34，长期：MD -0.69，95% CrI -1.31至-0.08）产生了显著差异。然而，各小组之间的FOGQ评分未发现统计学差异。根据曲线下面积排序区域，HFrTMS在短期UPDRS-III评分（0.77）、短期（0.82）和长期（0.84）TUGT时间以及短期FOGQ评分（0.73）方面排名第一。关于安全性结局，所有策略显示的不良事件均较少且为自限性。
HFrTMS可能是改善PD患者运动功能的最佳非侵入性脑刺激（NIBS）干预措施，而NIBS总体上耐受性良好。然而，需要进一步开展针对tDCS和rTMS不同联合方案所产生临床结局的研究。
