Comparative efficacy of non-invasive brain stimulation for post-stroke aphasia: A network meta-analysis and meta-regression of moderators

Ding, Xiao-Di; Zhang, Shuangshuang; Huang, Wei; Zhang, Shaomin; Zhang, Li; Hu, Jiahui; Li, Juebao; Ge, Qiuhua; Wang, Yuanjiao; Ye, Xiangming; Zhang, Jie

doi:10.1016/j.neubiorev.2022.104804

Cited by 20 publications

(7 citation statements)

References 48 publications

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“…These results are consistent with the treatment effects on post-stroke aphasia. 54 However, in terms of rTMS, our results found that bilateral rTMS results in greater antidepressant effects than HFrTMS and LFrTMS in patients with PSD, which differs from a previous study showing that HFrTMS was more effective than LFrTMS and bilateral rTMS in adult unipolar and bipolar depression. 55 The reasons underpinning the different effects of bilateral and unilateral NIBS on improving PSD remain unclear, distinct effects on brain excitability may influence our findings.…”

Section: Discussioncontrasting

confidence: 99%

“…Our findings indicate that the use of dual tDCS may produce more favorable short‐term antidepressant outcomes compared to atDCS, which solely stimulates the left DLPFC in patients with PSD. These results are consistent with the treatment effects on post‐stroke aphasia 54 . However, in terms of rTMS, our results found that bilateral rTMS results in greater antidepressant effects than HFrTMS and LFrTMS in patients with PSD, which differs from a previous study showing that HFrTMS was more effective than LFrTMS and bilateral rTMS in adult unipolar and bipolar depression 55 .…”

Section: Discussionsupporting

confidence: 90%

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Non‐invasive brain stimulation for treating post‐stroke depression: A network meta‐analysis

Sun

Liu

et al. 2023

Int J Geriat Psychiatry

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Objective: To compare the antidepressant effects and tolerability of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) treatments in patients with post-stroke depression (PSD). Methods:We included randomized controlled trials comparing active stimulation with sham stimulation. Primary outcomes were the depression score after treatment, presented as standardized mean differences with 95% confidence intervals.Response/remission and long-term antidepressant efficacy were also examined. We estimated effect-size using pairwise and Bayesian network meta-analysis (NMA) with random-effects model. Results:We identified 33 studies (total n = 1793). In NMA, 5 of 6 treatment strategies were associated with higher effect compared with sham therapy: dual rTMS (standardized mean differences = −1.5; 95% confidence interval = −2.5 to −0.57), dual LFrTMS (−1.5, −2.4 to −0.61), dual tDCS (−1.1, −1.5 to −0.62), HFrTMS (−1.1, −1.3 to −0.85) and LFrTMS (−0.90, −1.2 to −0.6). And dual rTMS, dual LFrTMS or HFrTMS may be more effective than other interventions for achieving antidepressant effects. Regarding secondary outcomes, rTMS can promote depression remission and response, and alleviate depression for at least 1 month. rTMS and tDCS were well tolerated. Conclusions: Bilateral rTMS and HFrTMS are considered top-priority non-invasive brain stimulation (NIBS) interventions for improving PSD. Dual tDCS and LFrTMS are also efficient.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 90%

Non‐invasive brain stimulation for treating post‐stroke depression: A network meta‐analysis

Sun

Liu

et al. 2023

Int J Geriat Psychiatry

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“…Studies that did not report the value of a moderator were excluded from the meta‐regression analysis. Gibbs sampling was based on 250,000 iterations following 50,000 burn‐in iterations, and the number of iterations was determined by evaluating trace plots and convergence criteria 56,57 . Moderator effects were measured using the regression coefficient β.…”

Section: Methodsmentioning

confidence: 99%

“…Gibbs sampling was based on 250,000 iterations following 50,000 burn-in iterations, and the number of iterations was determined by evaluating trace plots and convergence criteria. 56,57 Moderator effects were measured using the regression coefficient β. We also assessed their influence as the change in the SD of the NMA models before and after introducing the moderators and rerunning the meta-regression.…”

Section: Meta-regression Analysesmentioning

confidence: 99%

Efficacy of scalp stimulation for multidomain cognitive impairment in patients with post‐stroke cognitive impairment and dementia: A network meta‐analysis and meta‐regression of moderators

Xu,

Li,

Zhang

et al. 2023

J Evidence Based Medicine

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BackgroundScalp stimulation has gained more traction for post‐stroke cognitive impairment and dementia (PSCID); the interaction between stimulation targets and parameters influences the response to the stimulation. However, the most efficacious treatment for improving different domains of cognitive impairment remains unknown.ObjectiveWe aimed to conduct a systematic review and network meta‐analysis (NMA) to compare the efficacy of various scalp stimulation protocols used in PSCID treatment.MethodsRandomized controlled trials of scalp stimulation in patients with PSCID were searched in eight databases over the past 20 years. Standardized mean differences (SMDs) for global and subdomain cognitive scores were pooled in Bayesian NMA. Moderators were examined using meta‐regression analysis.ResultsA total of 90 trials, with 6199 patients, were included. Low‐frequency repetitive transcranial magnetic stimulation (rTMS) over the unaffected dorsolateral prefrontal cortex (DLPFC) was highly suggested for alleviating global severity (SMD = 1.11, 95% CI (0.64, 1.57)). High‐frequency rTMS over the left DLPFC was recommended for language use (1.85 (1.18, 2.52)), executive function (0.85 (0.36, 1.33)), orientation deficits (0.59 (0.07, 1.13)), and attention (0.85 (0.27, 1.43)). Anodal transcranial direct current stimulation over the affected DLPFC (2.03 (0.72, 3.34)) was recommended for treating memory impairment. Meta‐regression analyses showed significant associations within attention, language and orientation.ConclusionOverall, different cognitive domains have different optimal scalp stimulation prescriptions, and activating the affected key brain regions and inhibiting the unaffected area is still the most effective treatment.

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“…Noninvasive brain stimulation (NIBS) technology, such as repeated transcranial magnetic stimulation (rTMS), theta-burst stimulation (TBS), and transcranial direct current stimulation (tDCS), which can induce change in excitability of the underlying brain cortex in a noninvasive fashion and potentially induce long-lasting neuroplastic changes by either magnetic or electric fields, has gradually become more prevalent in stroke rehabilitation in recent years. 19–22 Briefly, TMS acts differently by generating a time-varying magnetic field perpendicular to the stimulation coil, which then induces a current in the superficial cerebral cortex nearly parallel to the coil, by affecting the excitability of neurons. Different stimulation frequencies have different effects on cortical activity, with high-frequency (> 1 Hz) stimulation (HF-rTMS) promoting local neuronal excitability, while low-frequency (⩽ 1 Hz) stimulation (LF-rTMS) shows inhibitory effects.…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy of different noninvasive brain stimulation therapies for recovery of global cognitive function, attention, memory, and executive function after stroke: a network meta-analysis of randomized controlled trials

Wang

Wan

Chen

et al. 2023

Therapeutic Advances in Chronic Disease

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Background: Which noninvasive brain stimulation (NIBS) treatment – transcranial direct current stimulation (tDCS) or transcranial magnetic stimulation (TMS) – is more beneficial for stroke patients’ cognitive rehabilitation is still up for debate. Objectives: Our goal is to provide an overview of the research on the effectiveness and safety of various NIBS protocols. Design: Systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs). Methods: This NMA compared any active NIBS versus sham stimulation in adult stroke survivors to enhance cognitive function, with a focus on global cognitive function (GCF), attention, memory, and executive function (EF) using the databases MEDLINE, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. The NMA statistical approach was built on a frequency framework. The effect size was estimated by the standardized mean difference (SMD) and a 95% confidence interval (CI). We compiled a relative ranking of the competing interventions based on their surface under the cumulative ranking curve (SUCRA). Results: NMA showed that high-frequency repeated TMS (HF-rTMS) improved GCF compared with sham stimulation (SMD = 1.95; 95% CI: 0.47–3.43), while dual-tDCS improved memory performance versus sham stimulation significantly (SMD = 6.38; 95% CI: 3.51–9.25). However, various NIBS stimulation protocols revealed no significant impact on enhancing attention, executive function, or activities of daily living. There was no significant difference between the active stimulation protocols for TMS and tDCS and sham stimulation in terms of safety. Subgroup analysis demonstrated an effect favoring activation site of the left dorsolateral prefrontal cortex (DLPFC) (SUCRA = 89.1) for enhancing GCF and bilateral DLPFC (SUCRA = 99.9) stimulation for enhancing memory performance. Conclusion: The HF-rTMS over the left DLPFC appears to be the most promising NIBS therapeutic option for improving global cognitive performance after stroke, according to a comparison of numerous NIBS protocols. Furthermore, for patients with post-stroke memory impairment, dual-tDCS over bilateral DLPFC may be more advantageous than other NIBS protocols. Both tDCS and TMS are reasonably safe. Registration: PROSPERO ID: CRD42022304865

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Comparative efficacy of non-invasive brain stimulation for post-stroke aphasia: A network meta-analysis and meta-regression of moderators

Cited by 20 publications

References 48 publications

Non‐invasive brain stimulation for treating post‐stroke depression: A network meta‐analysis

Non‐invasive brain stimulation for treating post‐stroke depression: A network meta‐analysis

Efficacy of scalp stimulation for multidomain cognitive impairment in patients with post‐stroke cognitive impairment and dementia: A network meta‐analysis and meta‐regression of moderators

Comparative efficacy of different noninvasive brain stimulation therapies for recovery of global cognitive function, attention, memory, and executive function after stroke: a network meta-analysis of randomized controlled trials

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