Uygur-Kucukseymen Elif, Pacheco-Barrios Kevin, Yuksel Burcu, Gonzalez-Mego Paola, Soysal Aysun, Fregni Felipe
Department of Neurology, Neurology Clinic of Kepez State Hospital, Antalya, Turkey.
Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Unidad de Investigacion para la Generacion y Sintesis de Evidencia en Salud, Universidad San Ignacio de Loyola, Vicerrectorado de Investigacion, Lima, Peru.
Mult Scler Relat Disord. 2023 Oct;78:104927. doi: 10.1016/j.msard.2023.104927. Epub 2023 Aug 4.
Non-invasive brain stimulation (NIBS) has demonstrated mixed effects on the clinical symptoms of multiple sclerosis. This systematic review and meta-analysis aimed to evaluate the effects of NIBS techniques on the most common symptoms of MS.
A literature search was performed until October 2022 which included randomized controlled trials and quasi-experimental studies that used sham-controlled NIBS in patients with MS. We calculated the Hedge's effect sizes of each domain of interest and their 95% confidence intervals (95% CIs) and performed random effects meta-analyses.
A total of 49 studies were included in the systematic review (944 participants). Forty-four eligible studies were included for quantitative analysis, of which 33 applied transcranial direct current stimulation (tDCS), 9 transcranial magnetic stimulation (TMS), and 2 transcranial random noise stimulation (tRNS). We found a significant decrease in fatigue (ES: - 0.86, 95% CI: - 1.22 to - 0.51, p < 0.0001), pain (ES: - 1.91, 95% CI, - 3.64 to - 0.19, p= 0.03) and psychiatric symptoms (ES: - 1.44, 95% CI - 2.56 to - 0.32, p = 0.01) in favor of tDCS compared with the sham. On the other hand, there was no strong evidence showing tDCS effectiveness on motor performance and cognition (ES: - 0.03, 95% CI - 0.35 to 0.28, p = 0.83 and ES: 0.71, 95% CI, - 0.09 to 1.52, p = 0.08, respectively). Regarding TMS, we found a significant decrease in fatigue (ES: - 0.45, 95% CI: - 0.84 to -0.07, p = 0.02) and spasticity levels (ES: - 1.11, 95% CI: - 1.48 to - 0.75, p < 0.00001) compared to the sham. However, there was no strong evidence of the effectiveness of TMS on motor performance (ES: - 0.39, 95% CI - 0.95 to 0.16, p = 0.16). Finally, there was no significant evidence showing the effectiveness of tRNS on fatigue levels (ES: - 0.28, 95% CI: - 1.02 to 0.47, p = 0.46) and cognitive improvement (ES: - 0.04, 95% CI: - 0.6, 0.52, p = 0.88) compared with the sham.
Overall, most studies have investigated the effects of tDCS on MS symptoms, particularly fatigue. The symptom that most benefited from NIBS was fatigue, while the least to benefit was motor performance. In addition, we found that disability score was associated with fatigue improvement. Thus, these findings support the idea that NIBS could have some promising effects on specific MS symptoms. It is also important to underscore that studies are very heterogeneous regarding the parameters of stimulation, and this may also have influenced the effects on some specific behavioral domains.
无创脑刺激（NIBS）已被证明对多发性硬化症的临床症状有不同的影响。本系统评价和荟萃分析旨在评估NIBS技术对多发性硬化症最常见症状的影响。
进行文献检索至2022年10月，纳入在多发性硬化症患者中使用假刺激对照的NIBS的随机对照试验和准实验研究。我们计算了每个感兴趣领域的Hedge效应量及其95%置信区间（95%CI），并进行随机效应荟萃分析。
系统评价共纳入49项研究（944名参与者）。44项符合条件的研究纳入定量分析，其中33项应用经颅直流电刺激（tDCS），9项应用经颅磁刺激（TMS），2项应用经颅随机噪声刺激（tRNS）。我们发现与假刺激相比，tDCS显著降低了疲劳（效应量：-0.86，95%CI：-1.22至- 0.51，p<0.0001）、疼痛（效应量：-1.91，95%CI：-3.64至-0.19，p = 0.03）和精神症状（效应量：-1.44，95%CI：-2.56至-0.32，p = 0.01）。另一方面，没有有力证据表明tDCS对运动表现和认知有效（效应量：-0.03，95%CI：-0.35至0.28，p = 0.83；效应量：0.71，9%CI：-0.09至1.52，p = 0.08）。关于TMS，我们发现与假刺激相比，疲劳（效应量：-0.45，95%CI：-0.84至-0.07，p = 0.02）和痉挛水平（效应量：-1.11，95%CI：-1.48至-0.75，p<0.00001）显著降低。然而，没有有力证据表明TMS对运动表现有效（效应量：-0.39，95%CI：-0.95至0.16，p = 0.16）。最后，没有显著证据表明与假刺激相比，tRNS对疲劳水平（效应量：-0.28，95%CI：-1.02至0.47，p = 0.46）和认知改善（效应量：-0.04，95%CI：-0.6至0.52，p = 0.88）有效。
总体而言，大多数研究调查了tDCS对多发性硬化症症状的影响，尤其是疲劳。从NIBS中获益最多的症状是疲劳，而获益最少的是运动表现。此外，我们发现残疾评分与疲劳改善相关。因此，这些发现支持NIBS可能对特定的多发性硬化症症状有一些有前景的影响这一观点。同样重要的是要强调，关于刺激参数，研究非常异质性，这也可能影响对某些特定行为领域的影响。
