Faculty of Rehabilitation, Shijonawate Gakuen University, Daitō, Japan.
Department of Physical Therapy, Showa University School of Nursing and Rehabilitation Sciences, Tokyo, Japan.
Mov Disord Clin Pract. 2024 Nov;11(11):1323-1334. doi: 10.1002/mdc3.14205. Epub 2024 Sep 2.
This systematic review and meta-analysis aimed to assess the effectiveness of non-invasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial electrical stimulation (tES), as a neurological intervention for degenerative cerebellar ataxia (DCA) based on preregistration (PROSPERO: CRD42023379192).
We aimed to explore clinical outcomes and examine the parameters associated with NIBS efficacy in DCA patients.
The PubMed, Cochrane Library, CHINAL, and PEDro databases were searched for relevant randomized controlled trials (RCTs). Data extraction, quality assessment, and heterogeneity analyses were conducted; the Grading, Recommendations, Assessment, Development, and Evaluation was used to assess the quality of evidence and a meta-analysis was performed.
Seventeen RCTs that included 661 patients on the scale for assessment and rating of ataxia (SARA) and 606 patients on the International Cooperative Ataxia Rating Scale (ICARS) were included. These RCTs showed a serious risk of bias (RoB) and low certainty of evidence for both outcomes. NIBS significantly reduced SARA (MD = -2.49, [95% confidence interval: -3.34, -1.64]) and ICARS (-5.27 [-7.06, -3.47]); the subgroup analysis showed significant effects: rTMS and tES reduced both outcomes. However, there were no significant differences in the effects of rTMS and tES. Additional subgroup analysis indicated the impact of rTMS frequency and the total number of tES sessions on ataxia.
Non-invasive brain stimulation may reduce ataxia in DCA patients, but the estimated effect size may change in future studies because the RoB was serious and the certainty of evidence was low, and the heterogeneity was high. To establish evidence for selecting NIBS methods and parameters, continued high-quality RCTs are required.
本系统评价和荟萃分析旨在评估非侵入性脑刺激（NIBS），包括重复经颅磁刺激（rTMS）和经颅电刺激（tES），作为退行性小脑共济失调（DCA）的神经干预措施的有效性，基于预先注册（PROSPERO：CRD42023379192）。
我们旨在探讨临床结局，并检查与 DCA 患者的 NIBS 疗效相关的参数。
检索 PubMed、Cochrane 图书馆、CHINAL 和 PEDro 数据库，以查找相关的随机对照试验（RCT）。进行数据提取、质量评估和异质性分析；使用 Grading、Recommendations、Assessment、Development、and Evaluation 评估证据质量，并进行荟萃分析。
纳入了 17 项 RCT，这些 RCT 包括 661 名 SARA 评分患者和 606 名 ICARS 评分患者。这些 RCT 在两个结局上均存在严重的偏倚风险（RoB）和低证据确定性。NIBS 显著降低了 SARA（MD=−2.49，[95%置信区间：−3.34，−1.64]）和 ICARS（−5.27 [−7.06，−3.47]）；亚组分析显示出显著的效果：rTMS 和 tES 均降低了这两个结局。然而，rTMS 和 tES 的效果没有显著差异。进一步的亚组分析表明 rTMS 频率和 tES 疗程总数对共济失调的影响。
非侵入性脑刺激可能会降低 DCA 患者的共济失调，但由于 RoB 严重且证据确定性低，异质性高，预计未来研究中估计的效果大小可能会发生变化。为了确定选择 NIBS 方法和参数的证据，需要进行持续的高质量 RCT。
