Effects of repetitive transcranial magnetic stimulation on gait disorders and cognitive dysfunction in Parkinson's disease: A systematic review with meta‐analysis

Abstract

Background Repetitive transcranial magnetic stimulation (rTMS) is acknowledged to be crucial to manage freezing of gait (FOG) and cognitive impairment for patients with Parkinson's disease (PD), but its effectiveness is unclear. Objective To determine the effects of rTMS on FOG and cognitive function in people with PD and to investigate potential factors that modulate the rTMS effects. Methods Databases searched included PubMed, Web of Science, EMBASE, and the Cochrane Library from inception to December 31, 2021. Eligible studies include a controlled randomized clinical trial of rTMS intervention for FOG and cognitive dysfunction in PD patients. The weighted mean difference (WMD) with 95% confidence intervals (CI) were calculated with fixed‐effects models. The outcome of the study included gait and cognitive assessments. Results Sixteen studies with a total of 419 patients were included. Fixed‐effects analysis revealed that rTMS was effective in improving freezing of gait questionnaire scores (short‐term effect: WMD = −0.925, 95% CI: −1.642 to −0.209, p = .011; long‐term effect: WMD = −2.120, 95% CI: −2.751 to −1.489, p = .000), 10‐m walking time (short‐term effect: WMD = −0.456, 95% CI: −0.793 to −0.119, p = .008; long‐term effect: WMD = −0.526, 95% CI: −0.885 to −0.167, p = .004), Timed Up‐and‐Go scores (short‐term effect: WMD = −1.064, 95% CI: −1.555 to −0.572, p = .000; long‐term effect: WMD = −1.097, 95% CI: −1.422 to −0.772, p = .000), Montreal cognitive assessment (WMD = 3.714, 95% CI: 2.567 to 4.861, p = .000), and frontal assessment battery (WMD = −0.584, 95% CI: −0.934 to −0.234, p = .001). Conclusions RTMS showed a beneficial effect on FOG and cognitive dysfunction in parkinsonism. However, the optimal rTMS protocol has not been determined and further high‐quality studies are needed.

Effects of non-invasive brain stimulation on walking and balance ability in Parkinson’s patients: A systematic review and meta-analysis

“…According to our analysis, two factors may have caused the above results. First, we consider that the diversity of the stimulation protocols utilized in each study was the cause (Lee et al, 2019;Nardone et al, 2020;de Oliveira et al, 2021;Nascimento et al, 2021;Pol et al, 2021;Deng et al, 2022;Krogh et al, 2022). Although our results did not reveal a statistically significant relationship between NIBS and gait speed, balance, or stride length, this does not mean that NIBS does not affect these outcomes.…”

“…There have been previous studies on the impact of NIBS on PD ( Helmich et al, 2006 ; Benninger and Hallett, 2015 ; Elsner et al, 2016 ), as well as several systematic reviews and meta-analyses ( Chou et al, 2015 ; Kim et al, 2019 ; Lee et al, 2019 ; Nardone et al, 2020 ; de Oliveira et al, 2021 ; Nascimento et al, 2021 ; Pol et al, 2021 ; Deng et al, 2022 ; Krogh et al, 2022 ). These studies assessed the effect of NIBS on motor symptoms ( de Oliveira et al, 2021 ), dyskinesia ( de Oliveira et al, 2021 ), and gait function ( Nardone et al, 2020 ; Pol et al, 2021 ; Deng et al, 2022 ) associated with PD.…”

“…There have been previous studies on the impact of NIBS on PD ( Helmich et al, 2006 ; Benninger and Hallett, 2015 ; Elsner et al, 2016 ), as well as several systematic reviews and meta-analyses ( Chou et al, 2015 ; Kim et al, 2019 ; Lee et al, 2019 ; Nardone et al, 2020 ; de Oliveira et al, 2021 ; Nascimento et al, 2021 ; Pol et al, 2021 ; Deng et al, 2022 ; Krogh et al, 2022 ). These studies assessed the effect of NIBS on motor symptoms ( de Oliveira et al, 2021 ), dyskinesia ( de Oliveira et al, 2021 ), and gait function ( Nardone et al, 2020 ; Pol et al, 2021 ; Deng et al, 2022 ) associated with PD. However, most of these studies were based on independent assessments of the rTMS intervention ( Chou et al, 2015 ; Nardone et al, 2020 ; Deng et al, 2022 ; Krogh et al, 2022 ) and the tDCS intervention ( Lee et al, 2019 ; de Oliveira et al, 2021 ; Nascimento et al, 2021 ; Pol et al, 2021 ) and featured fewer participants.…”

“…These studies assessed the effect of NIBS on motor symptoms ( de Oliveira et al, 2021 ), dyskinesia ( de Oliveira et al, 2021 ), and gait function ( Nardone et al, 2020 ; Pol et al, 2021 ; Deng et al, 2022 ) associated with PD. However, most of these studies were based on independent assessments of the rTMS intervention ( Chou et al, 2015 ; Nardone et al, 2020 ; Deng et al, 2022 ; Krogh et al, 2022 ) and the tDCS intervention ( Lee et al, 2019 ; de Oliveira et al, 2021 ; Nascimento et al, 2021 ; Pol et al, 2021 ) and featured fewer participants. Moreover, these studies did not compare the two interventions or examine them combined.…”

Longitudinal Studies on the Characteristics of TCM Constitutions and Related Factors of Women in Hong Kong

“…Furthermore, in the follow-up, the total number of unbalanced TCMC types owned by one person has increased, indicating an individual's health status could develop TCMC types. It is confirmed that TCMC types can influence the development of the disease [23,24]. Earlier, a pilot study recruited 218 participants with hepatic disease resulting in phlegm and dampness in the meridian during the early stage.…”