Effectiveness and safety of repetitive transcranial magnetic stimulation on memory disorder in stroke: A protocol for systematic review and meta-analysis

Abstract

Background: Approximately 23% to 55% of patients have memory impairments with a greatly negative effect on daily life 3 months after stroke. Repetitive transcranial magnetic stimulation (rTMS) has been widely used in the rehabilitation of stroke as it is safe, painless, and noninvasive. Moreover, few studies have investigated the effect of rTMS on poststroke memory disorder (PSMD). However, the efficacy of rTMS is not consistent and the optional stimulation frequency is unclear. Therefore, this protocol aims to evaluate the clinical effect and safety of rTMS on PSMD by analyzing results from randomized controlled trials.Methods: Search strategies will be performed on seven databases: PubMed, EMBASE, CENTRAL, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Wan Fang, and Technology Periodical Database (VIP). Only randomized controlled trials registered before August 2021 will be included. Additionally, the language will be limited to English or Chinese. For the outcome, we will focus on the Rivermead Behavioral Memory Test. Additionally, the Montreal Cognitive Assessment, Mini-mental State Examination, Modified Barthel Index, and advent events will be included. Two authors will independently select the study, extract data, and assess quality. Moreover, disagreements will be resolved by the third author. STATA 14 and Review Manager 5.4 will be used to perform the analysis. We will evaluate bias risk in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. To assess the quality of evidence, the Grading of Recommendations Assessment, Development, and Evaluation method will be employed.Results: This study will provide a comprehensive analysis of the current evidence on rTMS for PSMD. Conclusion:A reliable conclusion regarding whether rTMS is an effective and safe intervention for patients with PSMD and the effect of stimulation frequency and sham stimulation will be provided. This study will provide new insights for TMS in treating PSMD, and offer appropriate treatmentoptions to patients and clinicians.

Rehabilitation effect of core muscle training combined with functional electrical stimulation on lower limb motor and balance functions in stroke patients

“…Strokes mainly fall into hemorrhagic stroke and ischemic stroke. Despite diverse lesions of stroke, stroke-induced movement disorders have no obvious specificity, and the influence of age, stroke types, and onset latency on abnormal movement outcomes remains uncertain [ 5 ]. The causes for the above differences remain unclear.…”

“…Briefly speaking, movement disorders can be divided into hyperkinesia and abnormal involuntary movements. Generally, patients with movement disorders are mainly manifested as athetosis, dystonia, tremor, myoclonus, asterixis, stereotypes, akathisia, convulsions, vascular parkinsonism, progressive supranuclear palsy, and other hypokinetic diseases of insufficient movement or slowness (bradykinesia) [ 5 ]. Studies have claimed that approximately 30% of patients with chronic stroke suffer from persistent independent walking impairment [ 6 ].…”

Efficacy and Safety of Repetitive Transcranial Magnetic Stimulation for Poststroke Memory Disorder: A Meta-Analysis and Systematic Review

“…As mentioned in the Methods and published protocol section [32], a random-effect model or a fixed-effect model was applied to determine effect sizes. When I 2 = 0.00%, the fixed-effect model was employed; otherwise, the randomeffect model was applied.…”

Transcranial Magnetic Stimulation in Disorders of Consciousness: An Update and Perspectives

“…TMS or rTMS for the treatment of patients with DOC is believed to be safe and has the potential to increase the CRS-R scores of some patients. Based on the systematic review and metaanalysis, serious adverse events in animals and patients have not yet been described [54], although headache, epilepsy, head tinnitus, discomfort, hearing impairment, and local skin burns have been reported in patients with other neurological disorders after rTMS application [109][110][111]. Accidental seizures are the most serious side effects reported with TMS to date [109,111]; however, they have not been found among thousands of healthy and depressed subjects treated with rTMS [109], indicating that rTMS may be responsible for the later development of 'spontaneous' seizures in a few patients with pre-existing neuropathology.…”