Comparative efficacy of transcranial magnetic stimulation on different targets in Parkinson's disease: A Bayesian network meta-analysis.
Comparative efficacy of transcranial magnetic stimulation on different targets in Parkinson's disease: A Bayesian network meta-analysis.
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DOI：
10.3389/fnagi.2022.1073310
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发表时间：
2022
影响因子：
4.8
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经颅磁刺激(TMS)治疗帕金森病(PD)的疗效因刺激靶点不同而异。本研究旨在评估不同TMS靶点对帕金森病患者运动症状的影响。建立贝叶斯层次模型来评估不同TMS目标之间的影响，并计算排序概率和累积排序曲线下的表面(SUCRA)值来确定每个目标的排序。主要结果是统一的帕金森氏病评定量表第三部分。直接比较和间接比较之间的不一致性使用节点分裂法进行评估。纳入了36项试验，1122名受试者用于分析。配对Meta分析结果显示，TMS能显著改善PD患者的运动症状。网络Meta分析结果显示，高频刺激双侧M1、双侧DLPFC和M1+DLPFC可显著降低UPDRS-III评分。与其他参数相比，高频刺激对M1和DLPFC的影响更为显著，且以最高的Scura值排在第一位。直接比较和间接比较之间没有明显的不一致。考虑到我们研究中报告的所有设置，高于双侧M1或双侧DLPFC的高频刺激对改善PD(高置信度等级)的运动症状具有适度的有益效果。高于M1+DLPFC的高频刺激具有显著的有益效果，似乎是改善PD患者运动症状的最有效的TMS参数设置(高置信度)。
The efficacy of transcranial magnetic stimulation (TMS) on Parkinson’s disease (PD) varies across the stimulation targets. This study aims to estimate the effect of different TMS targets on motor symptoms in PD. A Bayesian hierarchical model was built to assess the effects across different TMS targets, and the rank probabilities and the surface under the cumulative ranking curve (SUCRA) values were calculated to determine the ranks of each target. The primary outcome was the Unified Parkinson’s Disease Rating Scale part-III. Inconsistency between direct and indirect comparisons was assessed using the node-splitting method. Thirty-six trials with 1,122 subjects were included for analysis. The pair-wise meta-analysis results showed that TMS could significantly improve motor symptoms in PD patients. Network meta-analysis results showed that the high-frequency stimulation over bilateral M1, bilateral DLPFC, and M1+DLPFC could significantly reduce the UPDRS-III scores compared with sham conditions. The high-frequency stimulation over both M1 and DLPFC had a more significant effect when compared with other parameters, and ranked first with the highest SCURA value. There was no significant inconsistency between direct and indirect comparisons. Considering all settings reported in our research, high-frequency stimulation over bilateral M1 or bilateral DLPFC has a moderate beneficial effect on the improvement of motor symptoms in PD (high confidence rating). High-frequency stimulation over M1+DLPFC has a prominent beneficial effect and appears to be the most effective TMS parameter setting for ameliorating motor symptoms of PD patients (high confidence rating).