重复经颅磁刺激联合重复外周磁刺激对脑卒中后上肢运动功能的影响：一项系统评价和荟萃分析

Effects of repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation on upper limb motor function after stroke: a systematic review and meta-analysis.

作者信息

Luo Shanshan, Wen Zhu, Liu Ying, Sun Tao, Xu Li, Yu Qian

机构信息

Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.

School of Clinical Medicine, Southwest Medical University, Luzhou, China.

出版信息

Front Neurol. 2024 Nov 12;15:1472837. doi: 10.3389/fneur.2024.1472837. eCollection 2024.

DOI:10.3389/fneur.2024.1472837

PMID:39600429

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11588637/

Abstract

OBJECTIVE

To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) combined with repetitive peripheral magnetic stimulation (rPMS) on upper limb motor dysfunction after stroke.

METHODS

We systematically searched databases up to May 2024, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, Wanfang, and CBM. Randomized controlled trials (RCTs) examining the application of rTMS combined rPMS on upper limb motor dysfunction after stroke were included based on predefined inclusion criteria. We used Cochrane Risk of Bias 2 tool to assess bias risk of the included RCTs. Meta-analysis was conducted using RevMan 5.4 and Stata 17.0 software.

RESULTS

A total of 9 RCTs involving 483 participants were included in this study. Compared with the control groups that used either conventional therapy or rTMS alone, the experimental group that used rTMS combined rPMS showed significant improvements in stroke patients' upper limb motor function [MD = 3.65, 95% CI (2.75, 4.54), < 0.05], ability of daily living [MD = 4.50, 95% CI (3.50, 5.50), < 0.05], and spasticity [MD = -0.34, 95% CI (-0.48, -0.20), < 0.05]. Meanwhile, in terms of neurophysiological indicators, significant differences were found both for motor evoked potential latency [MD = -1.77, 95% CI (-3.19, -0.35), < 0.05] and motor evoked potential amplitude [MD = 0.25, 95% CI (0.01, 0.49), < 0.05].

CONCLUSION

This study provides low-level evidence that the therapy of LF-rTMS or HF-rTMS combined with rPMS can improve the upper limb motor function and daily living ability of stroke patients. However, given that the low quality of the evidence for the evaluation results, further evidence from high-quality studies is needed to substantiate this conclusion.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024539195, PROSPERO Platform [CRD42024539195].

摘要

目的

评估重复经颅磁刺激（rTMS）联合重复外周磁刺激（rPMS）对脑卒中后上肢运动功能障碍的疗效。

方法

我们系统检索了截至2024年5月的数据库，包括PubMed、Embase、Cochrane图书馆、科学网、中国知网、维普、万方和中国生物医学文献数据库。根据预先设定的纳入标准，纳入了研究rTMS联合rPMS应用于脑卒中后上肢运动功能障碍的随机对照试验（RCT）。我们使用Cochrane偏倚风险2工具评估纳入的RCT的偏倚风险。使用RevMan 5.4和Stata 17.0软件进行荟萃分析。

结果

本研究共纳入9项RCT，涉及483名参与者。与单独使用传统疗法或rTMS的对照组相比，使用rTMS联合rPMS的实验组在脑卒中患者的上肢运动功能[MD = 3.65，95%CI（2.75，4.54），P < 0.05]、日常生活能力[MD = 4.50，95%CI（3.50，5.50），P < 0.05]和痉挛[MD = -0.34，95%CI（-0.48，-0.20），P < 0.05]方面均有显著改善。同时，在神经生理指标方面，运动诱发电位潜伏期[MD = -1.77，95%CI（-3.19，-0.35），P < 0.05]和运动诱发电位波幅[MD = 0.25，95%CI（0.01，0.49）），P < 0.05]均存在显著差异。