Lin Yi-Cheng, Kuo Sheng-Han, Lin Chin-Po, Chang Li-Hung
Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
Department of Neurology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA.
J Chin Med Assoc. 2025 Jun 1;88(6):417-424. doi: 10.1097/JCMA.0000000000001243. Epub 2025 Apr 30.
Spinocerebellar ataxia (SCA) is a group of hereditary neurodegenerative disorders characterized by the progressive incoordination of gait, impaired motor control, and various neurological deficits. Therapeutic options for SCA remain limited. However, repetitive transcranial magnetic stimulation (rTMS) has gained attention as a potential intervention due to its noninvasive nature, ease of application, and favorable safety profile. To evaluate the therapeutic efficacy of rTMS in SCA, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs). A comprehensive search of PubMed, Medline, and the Cochrane Library databases was conducted to identify RCTs assessing rTMS for SCA management. The primary outcomes of interest included changes in motor function as measured by the Scale for the Assessment and Rating of Ataxia (SARA) or the International Cooperative Ataxia Rating Scale (ICARS). Our analysis included eight RCTs involving a total of 237 participants. Meta-analysis results demonstrated statistically significant improvements in motor function. Specifically, SARA scores showed a mean difference (MD) of -1.56 (95% CI, -2.88 to -0.24; p = 0.02), and ICARS scores improved with an MD of -3.16 (95% CI, -3.93 to -2.39; p < 0.001) compared with a sham group. To evaluate the effects of different rTMS protocols on SCA, we performed subgroup analyses of low-frequency (LF), high-frequency (HF), and intermittent theta burst stimulation (iTBS). We revealed that LF (MD, -1.60; 95% CI, -3.06 to -0.13; p = 0.03) and iTBS (MD, -1.68; 95% CI, -2.29 to -1.08; p < 0.001) were effective in significantly improving SARA. The HF group showed a reduction in SARA scores (MD, -1.52; 95% CI, -6.34 to 3.30; p = 0.54) but without significance because of the small sample size. These findings indicate that overall rTMS is a promising therapeutic approach for alleviating motor symptoms in hereditary SCA patients.
脊髓小脑共济失调（SCA）是一组遗传性神经退行性疾病，其特征为步态逐渐共济失调、运动控制受损以及各种神经功能缺损。SCA的治疗选择仍然有限。然而，重复经颅磁刺激（rTMS）因其无创性、易于应用和良好的安全性而作为一种潜在干预手段受到关注。为了评估rTMS对SCA的治疗效果，我们对随机对照试验（RCT）进行了系统评价和荟萃分析。对PubMed、Medline和Cochrane图书馆数据库进行了全面检索，以确定评估rTMS用于SCA管理的RCT。感兴趣的主要结局包括通过共济失调评估和评分量表（SARA）或国际协作共济失调评分量表（ICARS）测量的运动功能变化。我们的分析纳入了八项RCT，共涉及237名参与者。荟萃分析结果显示运动功能有统计学意义的改善。具体而言，与假刺激组相比，SARA评分的平均差值（MD）为-1.56（95%CI，-2.88至-0.24；p = 0.02），ICARS评分改善，MD为-3.16（95%CI，-3.93至-2.39；p < = 0.001）。为了评估不同rTMS方案对SCA的影响，我们对低频（LF）、高频（HF）和间歇性theta爆发刺激（iTBS）进行了亚组分析。我们发现低频（MD，-1.60；95%CI，-3.06至-0.13；p = 0.03）和iTBS（MD，-1.68；95%CI，-2.29至-1.08；p < = 0.001）在显著改善SARA方面有效。高频组SARA评分降低（MD，-1.52；95%CI，-6.34至3.30；p = = = 0.54），但由于样本量小而无显著性。这些发现表明，总体而言，rTMS是缓解遗传性SCA患者运动症状的一种有前景的治疗方法。
