Repetitive transcranial magnetic stimulation therapy for motor recovery in Parkinson's disease: A Meta‐analysis

Abstract

IntroductionTherapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on motor recovery of Parkinson's disease (PD) have been reported; however, the protocols of these studies varied greatly. The aim of this meta‐analysis was to evaluate the optimal rTMS parameters for motor recovery of PD.MethodsElectronic databases were searched for studies investigating the therapeutic effects of rTMS on motor function in patients with PD. The section III of the Unified Parkinson's Disease Rating Scale (UPDRS) was extracted as the primary outcome, and the standardized mean difference (SMD) with 95% confidence interval (CI) was calculated.ResultsTwenty‐three studies with a total of 646 participants were included. The pooled estimates of rTMS revealed significant short‐term (SMD, 0.37; p < 0.00001) and long‐term (SMD, 0.39; p = 0.005) effects on motor function improvement of PD. Subgroup analysis observed that high‐frequency rTMS (HF‐rTMS) was significant in improving motor function (SMD, 0.48; p < 0.00001), but low‐frequency rTMS (LF‐rTMS) was not. In particular, when HF‐rTMS targeted over the primary motor cortex (M1), in which the bilateral M1 revealed a larger effect size than unilateral M1. Compared to single‐session, multi‐session of HF‐rTMS over the M1 showed significant effect size. In addition, HF‐rTMS over the M1 with a total of 18,000–20,000 stimulation pulses yielded more significant effects (SMD, 0.97; p = 0.01) than other dosages.ConclusionsIn conclusion, multi‐session of HF‐rTMS over the M1 (especially bilateral M1) with a total of 18,000–20,000 pulses appears to be the optimal parameters for motor improvement of PD.

Quantitative Electroencephalography Characteristics for Parkinson’s Disease: A Systematic Review

“…In summary, the slower activity found in PD patients with motor impairment suggests that these patients could be benefit with excitatory NIBS over frontal and central cortical areas. Several studies have demonstrated that excitatory NIBS has beneficial effect for the treatment of motor symptoms in patients with PD [9][10][11]52]. Though the mechanisms underlying these effects are unclear, the excitatory NIBS seems to be able to reverse the "slowing down" of cortical waves.…”

“…Individualized treatment guided by biomarkers certainly will play a crucial role in the more effective treatment of various neurological diseases in the near future [1]. By identifying the biomarkers in the brain of patients with PD may help, for example, in the decision-making process of health professionals regarding the non-invasive brain stimulation (NIBS) treatment, a useful and safe approach to sensorimotor rehabilitation for patients with PD [9][10][11]. Indeed, NIBS treatment seems to modulate qEEG abnormalities in other neurodegenerative disease [12,13].…”

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“…The analysis also suggested that multiple sessions and higher total number of stimulation pulses are associated with higher effect size for long‐term UPDRS III scores . For rTMS frequency, one meta‐analysis suggested that multiple sessions of high‐frequency, bilateral M1 rTMS provided greater benefit than single‐session, low‐frequency, or unilateral M1 rTMS …”

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“…III. Recovery: rTMS has a positive impact on functional recovery, such as limb motor recovery in stroke patients; however, optimal rTMS parameters and high-quality evidence require further research (Pollock et al, 2014;Boonzaier et al, 2018;Yang et al, 2018;Xiang et al, 2019). IV.…”