Efficiency of repetitive transcranial magnetic stimulation on rehabilitation of motor function in patients with stroke: A systematic review

doi:10.3969/j.issn.2095-4344.2013.50.022

Abstract

Abstract:

BACKGROUND: Studies have different views on the effect of repetitive transcranial magnetic stimulation applied in stroke patients for improving motor function.
OBJECTIVE: To evaluate the effect of repetitive transcranial magnetic stimulation on rehabilitation of motor function in patients with stroke.
METHODS: We searched Cochrane Central Register of Controlled Trials, PubMed, ISI Web of science, Medline, EMBASE, China Biology Medicine disc, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodical, Wanfang Data (from database building to July 2013) for randomized controlled trials concerning repetitive transcranial magnetic stimulation on improving motor function in patients with stroke. The included studies were evaluated according to the method recommended by the Cochrane Collaboration. Meta analysis was performed in qualified literatures. The extracted data were analyzed by RevMan 5.1 software and GRADEprofiler 3.6 software.
RESULTS AND CONCLUSION: A total of 23 trials were included (intervention group n=400, control group n=301). Quantitative analysis was conducted in seven studies, and descriptive study was performed in the remaining studies. Meta-analyses analyzed Fugl Meyer Motor Scale and Barthel index. Results showed that Fugl Meyer Motor Scale [SMD =0.48, 95%CI(0.10, 0.86)] and Barthel index [SMD=1.38, 95%CI (0.68, 2.09)] were significantly higher in the intervention group than that in the control group. In accordance with The Grading of Recommendations Assessment, Development and Evaluation, outcome indexes were evaluated, and the two indexes were graded low quality. The current evidence shows that repetitive transcranial magnetic stimulation appears to enhance motor function and activities of daily living of the patients with stroke. Considering the limitations of the included studies, more multi-central randomized controlled trials with large sample sizes and high qualities are required in future to verify the therapeutic efficacy of repetitive transcranial magnetic stimulation on motor function of stroke patients.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: stroke, repetitive transcranial magnetic stimulation, motor function, randomized controlled trials, evidence-based medicine

CLC Number:

R318

Zhu Yi, Yang Yu-jie, Gu Yi-huang, Xie Bin, Jin Hong-zhu. Efficiency of repetitive transcranial magnetic stimulation on rehabilitation of motor function in patients with stroke: A systematic review[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2013.50.022.

Figures/Tables 7

2.4 重复经颅磁刺激的治疗与康复效果评价 2.4.1 重复经颅磁刺激对脑卒中患者运动功能的影响主要评价指标Fugl-Meyer运动评分有4项研究报道了重复经颅磁刺激对脑卒中患者Fugl-Meyer运动评分的影响[17, 25-27]，共计156例患者。采用随机效应模型进行分析。结果显示，重复经颅磁刺激对脑卒中患者运动功能的治疗效果与对照组相比，其差异有显著性意义[SMD=0.48，95%CI(0.10,0.86)]，见图4。因研究数量有限，未能进行漏斗图分析。 2.4.2 重复经颅磁刺激对脑卒中患者日常生活活动能力的影响主要评价指标为Barthel指数：有6项研究报道了重复经颅磁刺激对脑卒中患者Barthel指数的影响[8, 25-29]，共计236例患者。采用随机效应模型进行分析。结果显示，重复经颅磁刺激对脑卒中患者日常生活活动能力的影响与对照组相比，其差异有显著性意义[SMD=1.38，95%CI(0.68，2.09)]，见图5。因研究数量有限，未能进行漏斗图分析。 2.4.3 重复经颅磁刺激对脑卒中患者其他能力的影响本文共纳入23项研究，其中英文18项，中文5项。定量分析7项研究，其中英文2项，中文5项。其余16项英文研究，作描述性分析，结果如下： Conforto等[7]2012年的研究结果显示，低频重复经颅磁刺激作用于早期脑卒中患者，治疗2周后患者的Jebsen手功能测试结果有明显提高，尤其1个月后患者“捡小物”、“叠加跳棋”的能力有明显改善，提示重复经颅磁刺激能有效改善脑卒中偏瘫患者手的运动功能。 Khedr等[9]2005年的研究结果显示，对早期脑卒中患者进行连续10 d的重复经颅磁刺激治疗，患者的斯堪的纳维亚卒中量表得分、美国国立卫生院神经功能缺损评分、Barthel指数均有明显改善。 Fregni等[10]2006年的研究结果显示，连续5 d的低频重复经颅磁刺激治疗，脑卒中患者手的运动功能有明显改善，且治疗效果可持续到2周。研究提示，随治疗周期增加重复经颅磁刺激的疗效可能得到了累积。"

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