期刊
STROKE
卷 43, 期 7, 页码 1849-1857出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/STROKEAHA.111.649756
关键词
meta-analysis; neuronal plasticity; repetitive transcranial magnetic stimulation (rTMS); motor function; stroke
资金
- Taipei Veterans General Hospital [V97ER3-006, VGHUST97-P6-24, V97C1-034, V98C1-095, V98ER3-002, VGH-S4--98-001, VGH-ER3-99-006, V99C1-156, V100C-146]
- National Science Council [NSC-95-2314-B-010-030-MY3, NSC-96-2628-B-010-030-MY3, NSC-98-2321-B-010-007, NSC-99-2321-B-010-004, NSC-99-2628-B-010--011-MY3]
- Ministry of Education , Taipei, Taiwan
Background and Purpose-The purpose of this study was to perform a meta-analysis of studies that investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on upper limb motor function in patients with stroke. Methods-We searched for randomized controlled trials published between January 1990 and October 2011 in PubMed, Medline, Cochrane, and CINAHL using the following key words: stroke, cerebrovascular accident, and repetitive transcranial magnetic stimulation. The mean effect size and a 95% CI were estimated for the motor outcome and motor threshold using fixed and random effect models. Results-Eighteen of the 34 candidate articles were included in this analysis. The selected studies involved a total of 392 patients. A significant effect size of 0.55 was found for motor outcome (95% CI, 0.37-0.72). Further subgroup analyses demonstrated more prominent effects for subcortical stroke (mean effect size, 0.73; 95% CI, 0.44-1.02) or studies applying low-frequency rTMS (mean effect size, 0.69; 95% CI, 0.42-0.95). Only 4 patients of the 18 articles included in this analysis reported adverse effects from rTMS. Conclusions-rTMS has a positive effect on motor recovery in patients with stroke, especially for those with subcortical stroke. Low-frequency rTMS over the unaffected hemisphere may be more beneficial than high-frequency rTMS over the affected hemisphere. Recent limited data suggest that intermittent theta-burst stimulation over the affected hemisphere might be a useful intervention. Further well-designed studies in a larger population are required to better elucidate the differential roles of various rTMS protocols in stroke treatment. (Stroke. 2012;43:1849-1857.)
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