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