College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.
Ergonomics and Vocational Rehabilitation Lab, College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.
Neurol Sci. 2024 Sep;45(9):4399-4416. doi: 10.1007/s10072-024-07504-w. Epub 2024 Apr 11.
The study aimed to evaluate, using a network meta-analysis, the effects of different transcranial magnetic stimulation (TMS) modalities on improving cognitive function after stroke.
Computer searches of the Cochrane Library, PubMed, Web of Science, Embass, Google Scholar, CNKI, and Wanfang databases were conducted to collect randomized controlled clinical studies on the use of TMS to improve cognitive function in stroke patients, published from the time of database construction to November 2023.
A total of 29 studies and 2123 patients were included, comprising five interventions: high-frequency rTMS (HF-rTMS), low-frequency rTMS (LF-rTMS), intermittent theta rhythm stimulation (iTBS), sham stimulation (SS), and conventional rehabilitation therapy (CRT). A reticulated meta-analysis showed that the rankings of different TMS intervention modalities in terms of the Montreal Cognitive Assessment (MoCA) scores, Mini-Mental State Examination scores (MMSE), and Modified Barthel Index (MBI) scores were: HF-rTMS > LF-rTMS > iTBS > SS > CRT; the rankings of different TMS intervention modalities in terms of the event-related potential P300. amplitude scores were HF-rTMS > LF-rTMS > iTBS > CRT > SS; the rankings of different TMS intervention modalities in terms of the P300 latency scores were: iTBS > HF-rTMS > LF-rTMS > SS > CRT. Subgroup analyses of secondary outcome indicators showed that HF-rTMS significantly improved Rivermead Behavior Memory Test scores and Functional Independence Measurement-Cognitive scores.
High-frequency TMS stimulation has a better overall effect on improving cognitive functions and activities of daily living, such as attention and memory in stroke patients.
本研究旨在通过网络荟萃分析评估不同经颅磁刺激（TMS）模式对改善脑卒中后认知功能的影响。
计算机检索 Cochrane 图书馆、PubMed、Web of Science、Embase、Google Scholar、中国知网（CNKI）和万方数据库，搜集关于 TMS 改善脑卒中患者认知功能的随机对照临床研究，检索时限均从建库起至 2023 年 11 月。
共纳入 29 项研究 2123 例患者，包括 5 种干预措施：高频 rTMS（HF-rTMS）、低频 rTMS（LF-rTMS）、间歇性 theta 节律刺激（iTBS）、假刺激（SS）和常规康复治疗（CRT）。网状荟萃分析结果显示，不同 TMS 干预模式在蒙特利尔认知评估量表（MoCA）评分、简易精神状态检查量表（MMSE）评分和改良巴氏指数（MBI）评分方面的排序为：HF-rTMS＞LF-rTMS＞iTBS＞SS＞CRT；在事件相关电位 P300 波幅评分方面的排序为：HF-rTMS＞LF-rTMS＞iTBS＞CRT＞SS；在 P300 潜伏期评分方面的排序为：iTBS＞HF-rTMS＞LF-rTMS＞SS＞CRT。次要结局指标的亚组分析显示，HF-rTMS 可显著改善脑卒中患者的Rivermead 行为记忆测试评分和功能性独立测量认知评分。
高频 TMS 刺激对改善脑卒中患者的注意力和记忆力等认知功能以及日常生活活动能力具有更好的整体效果。
