Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China.
Department of Rehabilitation Medicine, Southwest Medical University, Luzhou, Sichuan, China.
Neurol Sci. 2024 Aug;45(8):3887-3899. doi: 10.1007/s10072-024-07455-2. Epub 2024 Mar 21.
BACKGROUND: Most stroke patients suffer from an imbalance in blood supply, which causes severe brain damage leading to functional deficits in motor, sensory, swallowing, cognitive, emotional, and speech functions. Repetitive transcranial magnetic stimulation (rTMS) is thought to restore functions impaired during the stroke process and improve the quality of life of stroke patients. However, the efficacy of rTMS in treating post-stroke function impairment varies significantly. Therefore, we conducted a meta-analysis of the number of patients with effective rTMS in treating post-stroke dysfunction. METHODS: The PubMed, Embase, and Cochrane Library databases were searched. Screening and full-text review were performed by three investigators. Single-group rate meta-analysis was performed on the extracted data using a random variable model. Then subgroup analyses were performed at the levels of stroke acuity (acute, chronic, or subacute); post-stroke symptoms (including upper and lower limb motor function, dysphagia, depression, aphasia); rTMS stimulation site (affected side, unaffected side); and whether or not it was a combination therapy. RESULTS: We obtained 8955 search records, and finally 33 studies (2682 patients) were included in the meta-analysis. The overall analysis found that effective strength (ES) of rTMS was 0.53. In addition, we found that the ES of rTMS from acute/subacute/chronic post-stroke was 0.69, 0.45, and 0.52. We also found that the ES of rTMS using high-frequency stimulation was 0.56, while the ES of rTMS using low-frequency stimulation was 0.53. From post-stroke symptoms, we found that the ES of rTMS in sensory aspects, upper limb functional aspects, swallowing function, and aphasia was 0.50, 0.52, 0.51, and 0.54. And from the site of rTMS stimulation, we found that the ES of rTMS applied to the affected side was 0.51, while the ES applied to the unaffected side was 0.54. What's more, we found that the ES of rTMS applied alone was 0.53, while the ES of rTMS applied in conjunction with other therapeutic modalities was 0.53. CONCLUSIONS: By comparing the results of the data, we recommend rTMS as a treatment option for rehabilitation of functional impairment in patients after stroke. We also recommend that rehabilitation physicians or clinicians use combination therapy as one of the options for patients.
背景：大多数中风患者都存在供血不平衡的情况，这会导致严重的脑损伤，从而导致运动、感觉、吞咽、认知、情感和言语功能障碍。重复经颅磁刺激（rTMS）被认为可以恢复中风过程中受损的功能，并提高中风患者的生活质量。然而，rTMS 治疗中风后功能障碍的疗效差异很大。因此，我们对 rTMS 治疗中风后功能障碍的有效患者数量进行了荟萃分析。
方法：检索 PubMed、Embase 和 Cochrane Library 数据库。由三位研究者进行筛选和全文审查。使用随机变量模型对提取的数据进行单组率荟萃分析。然后进行亚组分析，亚组分析水平为中风发病急缓（急性、慢性或亚急性）；中风后症状（包括上下肢运动功能、吞咽困难、抑郁、失语症）；rTMS 刺激部位（患侧、健侧）；是否为联合治疗。
结果：我们共获得了 8955 条检索记录，最终有 33 项研究（2682 名患者）纳入荟萃分析。总体分析发现 rTMS 的有效强度（ES）为 0.53。此外，我们发现急性/亚急性/慢性中风后 rTMS 的 ES 分别为 0.69、0.45 和 0.52。我们还发现高频刺激 rTMS 的 ES 为 0.56，低频刺激 rTMS 的 ES 为 0.53。从中风后症状来看，rTMS 在感觉方面、上肢功能方面、吞咽功能和失语症方面的 ES 分别为 0.50、0.52、0.51 和 0.54。而从 rTMS 刺激部位来看，rTMS 应用于患侧的 ES 为 0.51，应用于健侧的 ES 为 0.54。更重要的是，我们发现 rTMS 单独应用的 ES 为 0.53，而 rTMS 与其他治疗方式联合应用的 ES 为 0.53。
结论：通过比较数据结果，我们建议将 rTMS 作为中风后功能障碍康复的治疗选择。我们还建议康复医师或临床医生将联合治疗作为患者的选择之一。
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