Huang Yanbing, Li Caihui, Cai Rongda, Lin Tianlai, Chen Weiwen
Department of Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian Province, 362000, China.
Quanzhou First Hospital Affiliated to Fujian Medical University, No.250 East Street, Licheng District, Quanzhou, Fujian Province, 362000, China.
Neurol Sci. 2025 Apr;46(4):1525-1539. doi: 10.1007/s10072-024-07918-6. Epub 2024 Dec 21.
OBJECTIVE: This research aims to comprehensively assess the efficacy of intermittent theta-burst stimulation (iTBS) vs. high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in post-stroke dysfunction. MATERIALS AND METHODS: Until January 2024, extensive electronic database searches were conducted (PubMed, Embase, Cochrane Library, Web of Science, etc.). Fugl-Meyer Assessment for Upper Extremities (FMA-UE) was used to assess upper limb (UL) dysfunction; post-stroke dysphagia (PSD) was identified by Standardized Swallowing Assessment (SSA), Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), and Penetration/Aspiration Scale (PAS). Results were analyzed by network meta-analysis (NMA), and the mean difference (MD) and 95% confidence intervals (95% CI) were also reported. We conducted a descriptive analysis due to the inability to synthesize data on post-stroke cognitive impairment (PSCI). RESULTS: 19 studies were included for NMA analysis. For UL disorder, the efficacy of treatments was ranked as HF-rTMS [MD (95%CI):3.00 (1.69,4.31)], iTBS [MD (95%CI): 2.16 (0.84, 3.50)], and sham stimulation (reference). For PSD, the efficacy of treatment to reduce scores of FEDSS or SSA were iTBS [FEDSS, MD (95%CI): -0.80 (-1.13, -0.47); SSA, MD (95%CI): -3.37 (-4.36, -2.38)], HF-rTMS [FEDSS, MD (95%CI): -0.43 (-0.76, -0.10); SSA, MD (95%CI): -2.62 (-3.91, -1.35)], and sham stimulation(reference). Descriptive analysis of PSCI found that both iTBS and HF-rTMS were effective in improving PSCI. CONCLUSIONS: HF-rTMS demonstrates superior efficacy in UL dysfunction, while iTBS is more effective in PSD. Clinicians should carefully evaluate the type and severity of post-stroke dysfunction in each patient to select the most appropriate treatment.
目的:本研究旨在全面评估间歇性theta波爆发刺激(iTBS)与高频重复经颅磁刺激(HF-rTMS)对中风后功能障碍的疗效。 材料与方法:截至2024年1月,进行了广泛的电子数据库检索(PubMed、Embase、Cochrane图书馆、Web of Science等)。采用上肢Fugl-Meyer评估量表(FMA-UE)评估上肢(UL)功能障碍;通过标准化吞咽评估(SSA)、纤维内镜吞咽困难严重程度量表(FEDSS)和渗透/误吸量表(PAS)来识别中风后吞咽困难(PSD)。结果通过网络荟萃分析(NMA)进行分析,并报告平均差(MD)和95%置信区间(95%CI)。由于无法综合中风后认知障碍(PSCI)的数据,我们进行了描述性分析。 结果:纳入19项研究进行NMA分析。对于UL功能障碍,治疗效果排序为HF-rTMS [MD(95%CI):3.00(1.69,4.31)]、iTBS [MD(95%CI):2.16(0.84,3.50)]和假刺激(参照)。对于PSD,降低FEDSS或SSA评分的治疗效果为iTBS [FEDSS,MD(95%CI):-0.80(-1.13,-0.47);SSA,MD(95%CI):-3.37(-4.36,-2.38)]、HF-rTMS [FEDSS,MD(95%CI):-0.43(-0.76,-0.10);SSA,MD(95%CI):-2.62(-3.91,-1.35)]和假刺激(参照)。对PSCI的描述性分析发现,iTBS和HF-rTMS在改善PSCI方面均有效。 结论:HF-rTMS在UL功能障碍方面显示出更优的疗效,而iTBS在PSD方面更有效。临床医生应仔细评估每位患者中风后功能障碍的类型和严重程度,以选择最合适的治疗方法。
IEEE Trans Neural Syst Rehabil Eng. 2023
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