Zhang Lingwen, Jiang Yanhong, Fan Wenhui, Xue Hua
Department of Neurology, The Sixth People's Hospital of Chengdu, Chengdu, Sichuan, China.
Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China.
PLoS One. 2025 Jan 6;20(1):e0313420. doi: 10.1371/journal.pone.0313420. eCollection 2025.
Many systematic reviews (SRs) have reported the repetitive transcranial magnetic stimulation (rTMS) for Parkinson' s disease (PD), but the quality of the evidence is unclear. The aim of this study was to summarize the evidence provided by SRs on the effect of rTMS on PD.
A comprehensive search for SRs published from the establishment of the library to March 1, 2024, was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, VIP and Wanfang databases. The A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), the Risk of Bias for Systematic Reviews (ROBIS), and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool were used to evaluate the methodology quality, risk of bias and evidence quality of SRs, respectively.
We identified 16 SRs. According to the results of the AMSTAR-2, 12.5% (2/16) of the SRs rated as high quality, 43.75% (7/16) rated as low quality, and 43.75% (7/16) rated as very low quality. Based on the ROBIS tool, 6 (37.5%) SRs had low risk of bias. The GRADE results suggested that 16.13% (10/62) of the evidence was of moderate quality, 33.87% (21/62) of the evidence was of low quality and 50% (31/62) of the evidence was of very low quality. Moderate-quality results show that rTMS can improve PD motor symptoms.
Here we show that rTMS can improve the motor symptoms of PD, but its effectiveness in treating non-motor symptoms of PD is inconsistent. Due to the methodological limitations and diversity in study designs, future studies should focus on addressing these issues by providing thorough methodological details, standardizing rTMS protocols, evaluating side effects, and comparing with other treatments.
许多系统评价（SR）报告了重复经颅磁刺激（rTMS）治疗帕金森病（PD）的情况，但证据质量尚不清楚。本研究的目的是总结SR提供的关于rTMS对PD疗效的证据。
在PubMed、EMBASE、Cochrane图书馆、Web of Science、中国知网、维普和万方数据库中全面检索从建库至2024年3月1日发表的SR。分别使用系统评价评估工具2（AMSTAR-2）、系统评价偏倚风险（ROBIS）和推荐分级、评估、制定与评价（GRADE）工具来评估SR的方法学质量、偏倚风险和证据质量。
我们纳入了16篇SR。根据AMSTAR-2的结果，12.5%（2/16）的SR评为高质量，43.75%（7/16）评为低质量，43.75%（7/16）评为极低质量。基于ROBIS工具，6篇（37.5%）SR的偏倚风险较低。GRADE结果表明，16.13%（10/62）的证据质量为中等，33.87%（21/62）的证据质量为低，50%（31/62）的证据质量为极低。中等质量的结果表明rTMS可改善PD的运动症状。
我们在此表明rTMS可改善PD的运动症状，但其治疗PD非运动症状的有效性并不一致。由于方法学局限性和研究设计的多样性，未来研究应通过提供详细的方法学细节、规范rTMS方案、评估副作用以及与其他治疗方法进行比较来重点解决这些问题。
