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重复经颅磁刺激对脑卒中患者下肢运动功能的影响及最佳参数:系统评价和荟萃分析。

The effect and optimal parameters of repetitive transcranial magnetic stimulation on lower extremity motor function in stroke patient: a systematic review and meta-analysis.

机构信息

The Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, PR China.

Rehabilitation Department, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China.

出版信息

Disabil Rehabil. 2024 Oct;46(21):4889-4900. doi: 10.1080/09638288.2023.2283605. Epub 2023 Nov 22.


DOI:10.1080/09638288.2023.2283605
PMID:37991330
Abstract

PURPOSE: This study aimed to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in treating lower limb motor dysfunction after stroke and explore the optimal stimulation parameters. METHODS: PubMed, Embase, Cochrane Library, and other relevant databases were systematically queried for randomised controlled trials (RCTs) investigating the efficacy of rTMS in addressing lower limb motor dysfunction post-stroke. The search encompassed records from inception to July 2022. The assessed outcomes encompassed parameters such as the Fugl-Meyer motor function score for lower limbs, balance function, and Barthel index (BI). Three independent researchers were responsible for research selection, data extraction, and quality assessment. Study screening, data extraction, and bias evaluation were performed independently by two reviewers. Data synthesis was undertaken using Review Manager 5.3, while Stata version 14.0 software was employed for generating the funnel plot. RESULTS: A total of 13 studies and 428 patients were included. The meta-analysis indicated that rTMS had a positive effect on the BI (MD = 5.87, 95% CI [0.99, 10.76],  = 0.02, I2 = 86%, of studies = 8, of participants = 248). Subgroup analysis was performed on the stimulation frequency, treatment duration, and different stroke stages (stimulation frequency was low-frequency (LF)-rTMS (MD = 4.45, 95% CI [1.05, 7.85],  = 0.01, I2 = 0%, of studies = 4, of participants = 120); treatment time ≤ 15 d: (MD = 4.41, 95% CI [2.63, 6.18],  < 0.00001, I2 = 0%, of studies = 4, of participants = 124); post-stroke time ≤6 months: (MD = 4.37, 95% CI [2.42, 6.32],  < 0.0001, I2 = 0%, of studies = 5, of participants = 172). CONCLUSION: LF-rTMS had a significant improvement effect on BI score, while high-frequency (HF)-rTMS and iTBS had no significant effect. And stroke time ≤6 months in patients with treatment duration ≤15 d had the best treatment effect.

摘要

目的:本研究旨在评估重复经颅磁刺激(rTMS)治疗脑卒中后下肢运动功能障碍的疗效,并探讨最佳刺激参数。

方法:系统检索 PubMed、Embase、Cochrane 图书馆及其他相关数据库,以评估 rTMS 治疗脑卒中后下肢运动功能障碍的随机对照试验(RCT)。检索时间从建库至 2022 年 7 月。评估结果包括下肢 Fugl-Meyer 运动功能评分、平衡功能和 Barthel 指数(BI)等参数。由 3 名独立研究人员负责研究选择、数据提取和质量评估。两位审查员独立进行研究筛选、数据提取和偏倚评估。使用 Review Manager 5.3 进行数据综合,Stata 版本 14.0 软件生成漏斗图。

结果:共纳入 13 项研究,428 例患者。Meta 分析结果显示,rTMS 对 BI(MD=5.87,95%CI[0.99,10.76],P=0.02,I2=86%,研究数=8,参与者数=248)有积极影响。根据刺激频率、治疗持续时间和不同的脑卒中阶段进行亚组分析(刺激频率为低频(LF)-rTMS(MD=4.45,95%CI[1.05,7.85],P=0.01,I2=0%,研究数=4,参与者数=120);治疗时间≤15 d:(MD=4.41,95%CI[2.63,6.18],P<0.00001,I2=0%,研究数=4,参与者数=124);脑卒中发病时间≤6 个月:(MD=4.37,95%CI[2.42,6.32],P<0.0001,I2=0%,研究数=5,参与者数=172)。

结论:LF-rTMS 对 BI 评分有显著改善作用,而 HF-rTMS 和 iTBS 无显著作用。治疗时间≤15 d 的脑卒中发病时间≤6 个月的患者有最佳的治疗效果。

相似文献

[1]
The effect and optimal parameters of repetitive transcranial magnetic stimulation on lower extremity motor function in stroke patient: a systematic review and meta-analysis.

Disabil Rehabil. 2024-10

[2]
Comparative efficacy of different noninvasive brain stimulation protocols on upper-extremity motor function and activities of daily living after stroke: a systematic review and network meta-analysis.

Neurol Sci. 2024-8

[3]
Repetitive transcranial magnetic stimulation of lower limb motor function in patients with stroke: a systematic review and meta-analysis of randomized controlled trials.

Clin Rehabil. 2019-3-13

[4]
Excitatory Repetitive Transcranial Magnetic Stimulation Over the Ipsilesional Hemisphere for Upper Limb Motor Function After Stroke: A Systematic Review and Meta-Analysis.

Front Neurol. 2022-6-20

[5]
Effects of repetitive transcranial magnetic stimulation on lower extremity motor function and optimal parameters in stroke patients with different stages of stroke: a systematic evaluation and meta-analysis.

Front Neurol. 2024-7-26

[6]
Efficacy of coupling intermittent theta-burst stimulation and 1 Hz repetitive transcranial magnetic stimulation to enhance upper limb motor recovery in subacute stroke patients: A randomized controlled trial.

Restor Neurol Neurosci. 2020

[7]
Effects of repetitive transcranial magnetic stimulation combined with transcranial direct current stimulation on motor function and cortex excitability in subacute stroke patients: A randomized controlled trial.

Clin Rehabil. 2021-5

[8]
Effects of High-Frequency (HF) Repetitive Transcranial Magnetic Stimulation (rTMS) on Upper Extremity Motor Function in Stroke Patients: A Systematic Review.

Medicina (Kaunas). 2021-11-7

[9]
Comparative Efficacy of Different Repetitive Transcranial Magnetic Stimulation Protocols for Stroke: A Network Meta-Analysis.

Front Neurol. 2022-6-15

[10]
Repetitive transcranial magnetic stimulation for upper limb motor function and activities of daily living in patients with stroke: a protocol of a systematic review and Bayesian network meta-analysis.

BMJ Open. 2022-3-10

引用本文的文献

[1]
Effects of Cerebellar Transcranial Magnetic Stimulation on the Motor Function of Patients With Stroke: A Systematic Review and Meta-Analysis.

Brain Behav. 2025-4

[2]
Therapeutic efficacy of repetitive transcranial magnetic stimulation on gait and limb balance function in patients with lower limb dysfunction post-cerebral infarction: a systematic review and meta-analysis.

BMC Neurol. 2025-3-24

[3]
Effects of repetitive transcranial magnetic stimulation on lower extremity motor function and optimal parameters in stroke patients with different stages of stroke: a systematic evaluation and meta-analysis.

Front Neurol. 2024-7-26

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