TY - JOUR
T1 - Repetitive transcranial magnetic stimulation for lower extremity motor function in patients with stroke
T2 - A systematic review and network meta-analysis
AU - Xie, Yun Juan
AU - Chen, Yi
AU - Tan, Hui Xin
AU - Guo, Qi Fan
AU - Lau, Benson
AU - Gao, Qiang
N1 - Funding Information:
Funding: This work was supported by the 簃簃 project for disciplines of excellence 琀ሁ漁崁瘁崁?al Research Incubation Project 唀 ? est ?hina Hospital 唀 Sichuan University 唀 ?hina 唀 No 堀 HXFH 縁?o QG 缃? How to cite this article: Xie YJ唀 ?hen Y唀 Tan HX 唀 Guo QF唀 Lau B?M 唀 Gao Q 縃缀 Repetitive transcranial magnetic stimulation for lower extremity motor function in patients with stroke P a systematic review and network meta 爁ȁ瘁ȁ漁윁送崁逃堀 Neural Regen Res 縃缃P 爃堀
Funding Information:
original draft P YJX 嘀 methodology and investigation P Y? 唀 HXT 唀 QFG 嘀 resources P QFG 嘀 visualization P YJX 唀 Y? 唀 HXT 唀 QFG 唀 QG 嘀 software P YJX 唀 Y 嘀 manuscrip t review 頀 editing P QFG 唀 QG 嘀 supervision and project administration P QG 堀 All authors read and approved the final manuscript ? Conflicts of interest 圀 None declared ? inancial support 圀T his work was supported by the 簃簃 project for disciplines of excellence 琀ሁ漁崁瘁崁?al Research Incubation Project 唀 ? est ?hina Hospital 唀 Sichuan University 唀 ?hina 唀 No 堀 HXFH 縁?o QG 缃堀 The funding source had no role in study conception and design 唀 data analysis or interpretaton 唁褁ȁ褁ḁ谀 writing or deciding to submit this paper for publicaton ? Reporting statement ? This work followed the Preferred Reporting Items for Systematic Reviews and Meta 爀Analyses 縀PRISMA 缃? Copyright license agreement 圀 The ?opyright License Agreement has been signed by all authors before publication ? Data sharing statement 圀 Datasets analyzed during the current study are available from the corresponding author on reasonable request ? lagiarism check ? heck ed twice by iThenticate 堀 ?eer review 圀 Externally peer reviewed 堀 Open access statement 圀 This is an open access journal 唀 and articles are distributed under the terms of the reative ommons A ttribution ? Nonommercial 爀ShareAlik e 堃 License 唀 which allows others to remix 唀 tweak 唀 and build upon the work non 爁?ommercially 唀 as long as appropriate credit is given and the new creations are licensed under the identical terms ? Open peer reviewers 圀 Kamal Arya 唀 Institute for the Physically Handicapped 唀 Occupational Therapy India 嘀 Yulong Bai 唀 Huashan Hospital 唀 Fudan University 唀 ?hina ? Additional files ? Additional file 圀 PRISMA checklist ? Additional file 圀 Search strategy ? Additional file 圀 Open peer reviewer reports and ? Additional Table R? isk of bias assessment according to Physiotherapy Evidence Database scale ? Additional Table L圀ev els of evidence according to Grades of Recommendation 唀 Assessment 唀 Development 唀 and Evaluation scale ? Additional Table P? airwise meta 爁ȁ瘁ȁ漁윁送崁退 results of Fugl 爀Meyer assessment ? Additional Table P圀air wise meta 爁ȁ瘁ȁ漁윁送崁退 results of speed ? Additional Table R圀ela tive effects estimated from the network meta ? analysis with respect to speed and motor evoked potential amplitude ? Additional Table P圀air wise meta 爁ȁ瘁ȁ漁윁送崁退 results of balance ? Additional Table R圀ela tive effects estimated from the network meta ? analysis with respect to balance and Barthel Index ? Additional Table N? ode 爁送褁漁崁ꬁ瘁倀 approach for balance ? Additional Table P? airwise meta 爁ȁ瘁ȁ漁윁送崁退 results of motor evoked potential amplitude ? Additional Table Pa圀irw ise meta 爁ȁ瘁ȁ漁윁送崁退 results of Barthel Index ? Additional Figure 圀 Trace plot and density plot 堀 Additional Figure ? ?omparison 爁ȁᨁ椁딁?ted funnel plot of Fugl 爀Meyer assessment 縀A 缃唀 speed 縀B 缃唀 and balance 縀ሃ缃?
Publisher Copyright:
© 2021 Wolters Kluwer Medknow Publications. All rights reserved.
PY - 2020/11/27
Y1 - 2020/11/27
N2 - Transcranial magnetic stimulation, a type of noninvasive brain stimulation, has become an ancillary therapy for motor function rehabilitation. Most previous studies have focused on the effects of repetitive transcranial magnetic stimulation (rTMS) on motor function in stroke patients. There have been relatively few studies on the effects of different modalities of rTMS on lower extremity motor function and corticospinal excitability in patients with stroke. The MEDLINE, Embase, Cochrane Library, ISI Science Citation Index, Physiotherapy Evidence Database, China National Knowledge Infrastructure Library, and ClinicalTrials.gov databases were searched. Parallel or crossover randomized controlled trials that addressed the effectiveness of rTMS in patients with stroke, published from inception to November 28, 2019, were included. Standard pairwise meta-analysis was conducted using R version 3.6.1 with the 'meta' package. Bayesian network analysis using the Markov chain Monte Carlo algorithm was conducted to investigate the effectiveness of different rTMS protocol interventions. Network meta-analysis results of 18 randomized controlled trials regarding lower extremity motor function recovery revealed that low-frequency rTMS had better efficacy in promoting lower extremity motor function recovery than sham stimulation. Network meta-analysis results of five randomized controlled trials demonstrated that high-frequency rTMS led to higher amplitudes of motor evoked potentials than low-frequency rTMS or sham stimulation. These findings suggest that rTMS can improve motor function in patients with stroke, and that low-frequency rTMS mainly affects motor function, whereas high-frequency rTMS increases the amplitudes of motor evoked potentials. More high-quality randomized controlled trials are needed to validate this conclusion. The work was registered in PROSPERO (registration No. CRD42020147055) on April 28, 2020.
AB - Transcranial magnetic stimulation, a type of noninvasive brain stimulation, has become an ancillary therapy for motor function rehabilitation. Most previous studies have focused on the effects of repetitive transcranial magnetic stimulation (rTMS) on motor function in stroke patients. There have been relatively few studies on the effects of different modalities of rTMS on lower extremity motor function and corticospinal excitability in patients with stroke. The MEDLINE, Embase, Cochrane Library, ISI Science Citation Index, Physiotherapy Evidence Database, China National Knowledge Infrastructure Library, and ClinicalTrials.gov databases were searched. Parallel or crossover randomized controlled trials that addressed the effectiveness of rTMS in patients with stroke, published from inception to November 28, 2019, were included. Standard pairwise meta-analysis was conducted using R version 3.6.1 with the 'meta' package. Bayesian network analysis using the Markov chain Monte Carlo algorithm was conducted to investigate the effectiveness of different rTMS protocol interventions. Network meta-analysis results of 18 randomized controlled trials regarding lower extremity motor function recovery revealed that low-frequency rTMS had better efficacy in promoting lower extremity motor function recovery than sham stimulation. Network meta-analysis results of five randomized controlled trials demonstrated that high-frequency rTMS led to higher amplitudes of motor evoked potentials than low-frequency rTMS or sham stimulation. These findings suggest that rTMS can improve motor function in patients with stroke, and that low-frequency rTMS mainly affects motor function, whereas high-frequency rTMS increases the amplitudes of motor evoked potentials. More high-quality randomized controlled trials are needed to validate this conclusion. The work was registered in PROSPERO (registration No. CRD42020147055) on April 28, 2020.
KW - cortical excitability
KW - lower extremity
KW - motor function
KW - network meta-analysis
KW - noninvasive brain stimulation
KW - stroke
KW - systematic review
KW - transcranial magnetic stimulation
UR - http://www.scopus.com/inward/record.url?scp=85097405364&partnerID=8YFLogxK
U2 - 10.4103/1673-5374.300341
DO - 10.4103/1673-5374.300341
M3 - Review article
AN - SCOPUS:85097405364
SN - 1673-5374
VL - 16
SP - 1168
EP - 1176
JO - Neural Regeneration Research
JF - Neural Regeneration Research
IS - 6
ER -