Repetitive transcranial magnetic stimulation therapy for motor recovery in Parkinson's disease: A Meta‐analysis

Brain and Behavior - Tập 8 Số 11 - 2018
Chao-feng Yang1,2, Zhiwei Guo2, Haitao Peng2, Guoqiang Xing2,3, Huaping Chen2, Morgan A. McClure2, Bin He2, Lin He2, Fei Du4, Liangwen Xiong5, Qiwen Mu2,6
1Chengdu 363 Hospital of Southwest Medical University, Chengdu, China
2Department of Radiology & Imaging Institute of Rehabilitation and Development of Brain Function The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital Nanchong China
3Lotus Biotech.com LLC, John Hopkins University-MCC, Rockville, Maryland
4Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts
5Department of Genitourinary, The University of Texas MD Anderson Cancer Center, Houston, Texas
6Peking University Third Hospital, Beijing, China

Tóm tắt

AbstractIntroduction

Therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on motor recovery of Parkinson's disease (PD) have been reported; however, the protocols of these studies varied greatly. The aim of this meta‐analysis was to evaluate the optimal rTMS parameters for motor recovery of PD.

Methods

Electronic databases were searched for studies investigating the therapeutic effects of rTMS on motor function in patients with PD. The section III of the Unified Parkinson's Disease Rating Scale (UPDRS) was extracted as the primary outcome, and the standardized mean difference (SMD) with 95% confidence interval (CI) was calculated.

Results

Twenty‐three studies with a total of 646 participants were included. The pooled estimates of rTMS revealed significant short‐term (SMD, 0.37; p < 0.00001) and long‐term (SMD, 0.39; p = 0.005) effects on motor function improvement of PD. Subgroup analysis observed that high‐frequency rTMS (HF‐rTMS) was significant in improving motor function (SMD, 0.48; p < 0.00001), but low‐frequency rTMS (LF‐rTMS) was not. In particular, when HF‐rTMS targeted over the primary motor cortex (M1), in which the bilateral M1 revealed a larger effect size than unilateral M1. Compared to single‐session, multi‐session of HF‐rTMS over the M1 showed significant effect size. In addition, HF‐rTMS over the M1 with a total of 18,000–20,000 stimulation pulses yielded more significant effects (SMD, 0.97; p = 0.01) than other dosages.

Conclusions

In conclusion, multi‐session of HF‐rTMS over the M1 (especially bilateral M1) with a total of 18,000–20,000 pulses appears to be the optimal parameters for motor improvement of PD.

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Brain and Behavior

Tập 8 Số 11

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