经颅磁刺激辅助运动区对帕金森病运动功能的影响：系统评价与荟萃分析

Effects of non-invasive brain stimulation over the supplementary motor area on motor function in Parkinson's disease: A systematic review and meta-analysis.

作者信息

Chen Yawen, Jiang Hanhong, Wei Yixin, Ye Saiqing, Jiang Jiaxin, Mak Margaret K Y, Pang Marco Y C, Gao Qiang, Huang Meizhen

机构信息

Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, China; Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China.

出版信息

Brain Stimul. 2025 Jan-Feb;18(1):1-14. doi: 10.1016/j.brs.2024.12.005. Epub 2024 Dec 11.

DOI:10.1016/j.brs.2024.12.005

PMID:39667490

Abstract

BACKGROUND

Motor dysfunction profoundly affects individuals with Parkinson's disease (PD). Non-invasive brain stimulation (NIBS) targeting the supplementary motor area (SMA), a critical region for movement-related processing, offers a promising approach to enhance motor function for PD.

OBJECTIVE

This systematic review and meta-analysis aims to evaluate the efficacy of NIBS over the SMA (SMA-NIBS) in alleviating motor symptoms in PD.

METHODS

We conducted literature searches in MEDLINE, EMBASE, Physiotherapy Evidence Database, Web of Science, the Chinese National Knowledge Infrastructure, and Scopus. The meta-analysis utilized an inverse variance method and a random-effects model. Subgroup analyses were performed based on stimulation types (e.g., TMS and tDCS), stimulation protocols (e.g., facilitatory and inhibitory stimulation), and medication status during stimulation.

RESULTS

Twenty randomized control trials involving 442 individuals with PD were included. Compared to sham stimulation, SMA-NIBS significantly improved motor function as measured by the motor section of Unified Parkinson's Disease Rating Scale (UPDRS-III) (mean differences [MD]: -3.45, 95 % confidence interval [CI]: -5.65 to -1.26). Subgroup analysis revealed that only TMS (MD: -3.62, 95%CI: -6.15 to -1.08), not tDCS (MD: -2.47, 95 % CI: -5.03 to 0.08), has significant effect on motor function. Both facilitatory (MD: -2.59, 95 % CI: -3.37 to -1.82) and inhibitory stimulation (MD: -4.98, 95 % CI: -9.29 to -0.66) significantly improved the UPDRS-III score. Effectiveness was observed only during ON medication. Statistically significant effects of SMA-NIBS were reported on Freezing of Gait Questionnaire, not timed up and go test and walking speed.

CONCLUSION

SMA-NIBS is a promising approach to enhance motor function in PD.

摘要

背景

运动功能障碍对帕金森病（PD）患者有深远影响。针对辅助运动区（SMA）进行非侵入性脑刺激（NIBS），该区域是与运动相关处理的关键区域，为改善PD患者的运动功能提供了一种有前景的方法。

目的

本系统评价和荟萃分析旨在评估经颅磁刺激（NIBS）作用于辅助运动区（SMA-NIBS）对缓解PD患者运动症状的疗效。

方法

我们在MEDLINE、EMBASE、物理治疗证据数据库、科学网、中国知网和Scopus中进行了文献检索。荟萃分析采用逆方差法和随机效应模型。基于刺激类型（如重复经颅磁刺激和经颅直流电刺激）、刺激方案（如促进性和抑制性刺激）以及刺激期间的用药状态进行亚组分析。

结果

纳入了20项涉及442例PD患者的随机对照试验。与假刺激相比，SMA-NIBS显著改善了由统一帕金森病评定量表（UPDRS-III）运动部分测量的运动功能（平均差值[MD]：-3.45，95%置信区间[CI]：-5.65至-1.26）。亚组分析显示，只有重复经颅磁刺激（MD：-3.62，95%CI：-6.15至-1.08）对运动功能有显著影响，而经颅直流电刺激（MD：-2.47，95%CI：-5.03至0.08）则无显著影响。促进性刺激（MD：-2.59，95%CI：-3.37至-1.82）和抑制性刺激（MD：-4.98，95%CI：-9.29至-0.66）均显著改善了UPDRS-III评分。仅在服药期间观察到有效性。SMA-NIBS对步态冻结问卷有统计学显著影响，对计时起立行走测试和步行速度则无显著影响。