Zhu Yongxin, Yang Juncong, Wang Kun, Li Xianwen, Ling Jiahui, Wu Xie, Fu Lianhui, Qi Qi
Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China.
Shanghai University of Sport, Shanghai, China.
Brain Behav. 2025 Apr;15(4):e70471. doi: 10.1002/brb3.70471.
As the core of motor control and learning, the cerebellum is crucial for maintaining posture, regulating muscle tone, and coordinating movement. In recent years, there has been an increase in the number of studies on the application of cerebellar transcranial magnetic stimulation (cTMS) to motor dysfunction in patients with stroke. This review aims to analyze cTMS efficacy for stroke patients and further explore the specific effects of different stages of the disease, stimulation modes, stimulation intensity, and treatment duration.
Six databases were searched comprehensively-CNKI, Wanfang, Web of Science, PubMed, The Cochrane Library, and Embase-to collect randomized controlled trials (RCTs) up to October 2024 that investigated the improvement of physical motor dysfunction in stroke patients using cTMS. Two researchers screened the literature, extracted data, and independently assessed the quality and risk of bias of the included studies using the PEDro scale and the Cochrane Risk of Bias Assessment Tool 2. Meta-analysis was performed using RevMan 5.4.
A total of 20 RCTs with 812 participants were included. Meta-analysis and sensitivity analysis revealed that cTMS significantly improved BBS (Random, MD = 5.19, 95%CI = 3.66-6.72, p < 0.00001), enhanced FMA-LE scores (Random, MD = 1.88, 95%CI = 0.76-3.01, p = 0.001), shortened the TUG (Fix, MD = -1.64, 95%CI = -2.60 to -0.68, p = 0.0008), and 10MWT durations (Fix, MD = -7.66, 95%CI = -12.33 to -2.99, p = 0.001), and increased MEP amplitudes (Fix, MD = 0.45, 95%CI = 0.04-0.87, p = 0.03). Subgroup analysis of the BBS showed that cTMS had a significant effect on patients with stroke in the subacute phase (p < 0.00001), with improvements observed using HF-rTMS (p < 0.0001), iTBS (p < 0.00001), and intensities ≤ 80%RMT (< 80% RMT, p < 0.0001; 80% RMT, p < 0.00001). cTMS consistently demonstrated superior effects compared to controls across different intervention durations (5-10 sessions, p = 0.009; 11-20 sessions, p < 0.00001; > 20 sessions, p < 0.00001).
cTMS effectively improves motor function in patients with stroke, particularly during the subacute phase with excitatory stimulation and moderate intensities (≤ 80%RMT).
PROSPERO number: CRD42024540604.
作为运动控制与学习的核心，小脑对于维持姿势、调节肌张力及协调运动至关重要。近年来，小脑经颅磁刺激（cTMS）应用于中风患者运动功能障碍的研究数量有所增加。本综述旨在分析cTMS对中风患者的疗效，并进一步探讨疾病不同阶段、刺激模式、刺激强度及治疗时长的具体影响。
全面检索了六个数据库——中国知网、万方、科学网、PubMed、考克兰图书馆和Embase，以收集截至2024年10月的随机对照试验（RCT），这些试验研究了使用cTMS改善中风患者的身体运动功能障碍。两名研究人员筛选文献、提取数据，并使用PEDro量表和考克兰偏倚风险评估工具2独立评估纳入研究的质量和偏倚风险。使用RevMan 5.4进行荟萃分析。
共纳入20项RCT，812名参与者。荟萃分析和敏感性分析显示，cTMS显著改善了BBS（随机效应模型，MD = 5.19，95%CI = 3.66 - 6.72，p < 0.00001），提高了FMA - LE评分（随机效应模型，MD = 1.88，95%CI = 0.76 - 3.01，p = 0.001），缩短了TUG（固定效应模型，MD = -1.64，95%CI = -2.60至 -0.68，p = 0.0008）和10MWT时长（固定效应模型，MD = -7.66，95%CI = -12.33至 -2.99，p = 0.001），并增加了MEP波幅（固定效应模型，MD = 0.45，95%CI = 0.04 - 0.87，p = 0.03）。BBS的亚组分析表明，cTMS对亚急性期中风患者有显著影响（p < 0.00001），高频重复经颅磁刺激（HF - rTMS）（p < 0.0001）、间歇性θ波爆发刺激（iTBS）（p < 0.00001）以及强度≤80%静息运动阈值（< 80% RMT，p < 0.0001；80% RMT，p < 0.00001）均观察到改善。在不同干预时长下，cTMS与对照组相比始终显示出更好的效果（5 - 10次治疗，p = 0.009；11 - 20次治疗，p < 0.00001；> 20次治疗，p < 0.00001）。
cTMS有效改善中风患者的运动功能，尤其是在亚急性期采用兴奋性刺激和中等强度（≤80%RMT）时。
PROSPERO注册号：CRD42024540604。
