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.
Highlights
Therapeutic effects of repetitive transcranial magnetic stimulation on motor recovery of Parkinson’s disease (PD) have been reported; the protocols of these studies varied greatly
This meta‐analysis indicated more accurate evidence to support the efficacy of repetitive transcranial magnetic stimulation (rTMS) on motor recovery of PD patients
These results sug‐ gest that rTMS might be helpful in improving the motor deficits of PD
Summary
Parkinson’s disease (PD) is the second most common neurodegener‐ ative diseases worldwide (de Lau & Breteler, 2006) affecting about 6.2 million people globally in 2015 (Collaborators GMaCoD, 2016). Because the therapeutic effects of rTMS tended to be region‐specific (Kim, Kim, Chun, Yi, & Kwon, 2010; Levkovitz et al, 2015; Sasaki, Kakuda, & Abo, 2014) and de‐ pendent on stimulation frequency (Elahi & Chen, 2009) as well as sessions and pulses, (Chung & Mak, 2016) the aim of this meta‐anal‐ ysis was to investigate the rTMS stimulation parameters that pro‐ duced the optimal therapeutic effects on motor dysfunction of PD
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