Systematic review of parameters of stimulation, clinical trial design characteristics, and motor outcomes in non-invasive brain stimulation in stroke.
Systematic review of parameters of stimulation, clinical trial design characteristics, and motor outcomes in non-invasive brain stimulation in stroke.
复制标题
DOI：
10.3389/fpsyt.2012.00088
复制
发表时间：
2012
影响因子：
4.7
通讯作者：
Fregni F
中科院分区：
文献类型：
--
作者：
Adeyemo BO;Simis M;Macea DD;Fregni F
导言/目标：重复经颅磁刺激（rTMS）和经颅直流电刺激是两种强大的非侵入性神经调节疗法，有可能改变和评估皮质脊髓束的完整性。此外，最近的证据表明，脑刺激可能有利于中风恢复。因此，研究和投资可能改善神经康复中风恢复的创新疗法是研究和开发的下一步。参与者/材料和方法：本文介绍了rTMS和tDCS对运动功能治疗效果的最新系统评价。使用检索词"卒中"和"经颅刺激"进行文献检索。如果项目未能：（1）纳入卒中患者，（2）研究运动结局，或（3）纳入rTMS/tDCS作为治疗，则将其排除。其他排除包括：（1）综述、社论和信件，（2）动物或儿科人群，（3）病例报告或样本量≤ 2例患者，以及（4）吞咽困难、构音障碍、忽视或吞咽的主要结局。结果：2012年1月1日之前的PubMed英文数据库调查产生了695个适用结果。根据上述标准排除了研究，剩下50项研究。他们包括1314名参与者（1282名中风患者和32名健康受试者），他们在tDCS或rTMS前后进行运动功能评估。研究的运动评估之间的异质性很高，不能通过个体比较来解释。治疗后改善影响的合并效应量显示，tDCS和rTMS治疗刺激后持续明显改善。大多数研究对长期影响的随访有限。结论：从现有的研究中可以明显看出，无创刺激可以增强运动恢复，并可能导致卒中人群中具有临床意义的功能改善。仅报告了轻度至无不良事件。虽然结果是积极的，但文章之间的巨大异质性排除了确定的结论。
Introduction/Objectives: Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation are two powerful non-invasive neuromodulatory therapies that have the potential to alter and evaluate the integrity of the corticospinal tract. Moreover, recent evidence has shown that brain stimulation might be beneficial in stroke recovery. Therefore, investigating and investing in innovative therapies that may improve neurorehabilitative stroke recovery are next steps in research and development. Participants/Materials and Methods: This article presents an up-to-date systematic review of the treatment effects of rTMS and tDCS on motor function. A literary search was conducted, utilizing search terms “stroke” and “transcranial stimulation.” Items were excluded if they failed to: (1) include stroke patients, (2) study motor outcomes, or (3) include rTMS/tDCS as treatments. Other exclusions included: (1) reviews, editorials, and letters, (2) animal or pediatric populations, (3) case reports or sample sizes ≤2 patients, and (4) primary outcomes of dysphagia, dysarthria, neglect, or swallowing. Results: Investigation of PubMed English Database prior to 01/01/2012 produced 695 applicable results. Studies were excluded based on the aforementioned criteria, resulting in 50 remaining studies. They included 1314 participants (1282 stroke patients and 32 healthy subjects) evaluated by motor function pre- and post-tDCS or rTMS. Heterogeneity among studies’ motor assessments was high and could not be accounted for by individual comparison. Pooled effect sizes for the impact of post-treatment improvement revealed consistently demonstrable improvements after tDCS and rTMS therapeutic stimulation. Most studies provided limited follow-up for long-term effects. Conclusion: It is apparent from the available studies that non-invasive stimulation may enhance motor recovery and may lead to clinically meaningful functional improvements in the stroke population. Only mild to no adverse events have been reported. Though results have been positive results, the large heterogeneity across articles precludes firm conclusions.