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

Abstract

Background: Patients with post-stroke memory disorder (PSMD) have poor quality of life and it is necessary to identify more beneficial stimulation protocols for treatment with repetitive transcranial magnetic stimulation (rTMS). This meta-analysis was conducted to investigate the efficacy and safety of rTMS for improving memory performance, global cognition, and activities of daily living (ADL) among patients with PSMD. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang databases were screened to identify relevant randomized controlled trials. The primary outcome was memory performance; secondary outcomes included global cognition, ADL, and adverse events. STATA software was used to perform data synthesis. Results: Five articles with a total of 192 participants were included. The results indicated that rTMS was superior to control treatments for improving memory performance (mean difference [MD] = 1.73, 95% CI [Confidence Interval] [0.85, 2.60], p < 0.001), global cognition (MD = 2.44, 95% CI [0.96, 3.93], p < 0.001), and ADL (MD = 10.29, 95% CI [5.10, 15.48], p < 0.001). No significant differences were found between the low-frequency (LF) and high-frequency (HF) rTMS subgroups (p = 0.47, I 2 = 0.00%) or between the sham rTMS and non-rTMS subgroups (p = 0.94, I 2 = 0.00%). Four studies did not reported adverse events. Conclusions: rTMS may improve memory function, global cognition, and the ability to perform ADL in patients with PSMD. LF-rTMS and HF-rTMS may have equal efficacy for treatment of PSMD. Future studies should consider extending the follow-up period to explore the safety and long-term efficacy of rTMS for treatment of PSMD and the appropriate choice of placebo for clinical trials of this treatment.

Efficacy of repetitive transcranial magnetic stimulation in post-stroke cognitive impairment: an overview of systematic reviews

“…The radar plot demonstrates that all six evaluation dimensions of Xie et al ( 38 ) are higher than the rank average score, with a larger radar plot area and the highest significance in literature references. Three studies ( 33 , 41 , 46 ) had four evaluation dimensions below the rank average score, with smaller radar plot areas and lesser literature reference significance.…”

“…Seventeen articles had a score ranging from 5 to 11. Among them, three ( 33 , 42 , 44 ) studies scored 5, one ( 31 ) literature scored 6, one ( 41 ) literature scored 6.5, four ( 35 , 39 , 43 , 45 ) articles scored 7, one ( 34 ) literature scored 8, one ( 37 ) literature scored 9, three ( 32 , 36 , 40 ) articles scored 10, and three ( 38 , 46 , 47 ) articles scored 11. Refer to Table 2 for details.…”

“…No perfect scores were recorded, with only one ( 33 ) article scoring below 15. Thirteen ( 31 , 34–37 , 39–44 , 46 , 47 ) articles reported scores from 15 to 21, and four ( 32 , 38 , 45 ) articles reported scores from 21 to 27. Refer to Table 2 for details.…”

“…The average rank score of the 17 included articles ranged from 8.50 to 17.00, with an overall average rank score of 12.42. Xie et al ( 38 ) had the highest quality articles with an average rank score of 17.00, while Liu et al ( 42 ) had the lowest quality articles with an average rank score of 8.50. Only two articles ( 33 , 44 ) did not apply a forest plot to the stated results.…”

“…Thirteen studies included in the analysis ( 31–34 , 36 , 38–41 , 43 , 45–47 ) mentioned the occurrence of adverse effects following rTMS therapy. The frequently mentioned adverse effects were mild headache, dizziness, nausea, and vomiting, as well as other effects, including loss of appetite, anxiety, and fatigue.…”