Low-frequency repetitive transcranial magnetic stimulation on Parkinson motor function: a meta-analysis of randomised controlled trials

Zhu, Hang; Lu, Zhaoming; Jin, YiTing; Duan, Xiaojia; Teng, Junfang; Duan, Dong-Xiao

doi:10.1017/neu.2014.43

Cited by 32 publications

(27 citation statements)

References 33 publications

(41 reference statements)

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“…Distinct results, however, were observed in some other meta‐analysis studies in which no significant difference between HF‐rTMS and LF‐rTMS was found (Chou et al., ); an opposite result was discovered (Wagle Shukla et al., ) or no significant result was observed both in HF‐rTMS and LF‐rTMS (Chung & Mak, ). The reasons for these distinctions may be due to the differences in the included trials, (Zhu et al., ) data extraction, (Chou et al., ) and statistical methods (Wagle Shukla et al., ). Compared with these previous published meta‐analyses, this study enrolled more trials and calculated more detailed subgroup analyses.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…A RCT of repeated 50 Hz rTMS of both M1 did not show efficacy either (Benninger et al, 2012). The consortium concluded no evidence for therapeutic efficacy of low-frequency or unilateral high-frequency rTMS of M1 representation of the hand (Lefaucheur et al, 2014), but a more recent meta-analysis may suggest otherwise (Zhu et al, 2015).…”

Section: Therapeutic Studies Of Non-invasive Brain Stimulation In Parmentioning

confidence: 96%

“…Three meta-analyses concluded modest therapeutic efficacy in improving motor performance (Elahi, Elahi, & Chen, 2009;Fregni, Simon, Wu, & Pascual-Leone, 2005;Zhu et al, 2015). The number of clinical trials is rapidly increasing, but few follow current standards of randomized, controlled trials (RCT; see for a recent Consolidated Standards of Reporting Trials [CONSORT] Statement (Schulz, Altman, & Moher, 2010).…”

Section: Therapeutic Studies Of Non-invasive Brain Stimulation In Parmentioning

confidence: 99%

Non-invasive brain stimulation for Parkinson’s disease: Current concepts and outlook 2015

Hallett

2015

NRE

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Abstract. BACKGROUND AND PURPOSE:In advanced Parkinson's disease (PD), the emergence of symptoms refractory to conventional therapy poses a therapeutic challenge. The success of deep brain stimulation (DBS) and advances in the understanding of the pathophysiology of PD have raised interest in non-invasive brain stimulation as an alternative therapeutic tool. The rationale for its use draws from the concept that reversing abnormalities in brain activity and physiology thought to cause the clinical deficits may restore normal functioning. Currently the best evidence in support of this concept comes from DBS, which improves motor deficits, and modulates brain activity and motor cortex physiology, though whether a causal interaction exists remains largely undetermined. CONCLUSION: Most trials of non-invasive brain stimulation in PD have applied repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex and cortical areas of the motor circuit. Published studies suggest a possible therapeutic potential of rTMS and transcranial direct current stimulation (tDCS), but clinical effects so far have been small and negligible regarding functional independence and quality of life. Approaches to potentiate the efficacy of rTMS, including increasing stimulation intensity and novel stimulation parameters, derive their rationale from studies of brain physiology. These novel parameters simulate normal firing patterns or act on the hypothesized role of oscillatory activity in the motor cortex and basal ganglia in motor control. There may also be diagnostic potential of TMS in characterizing individual traits for personalized medicine.

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“…To date, five meta-analyses of the literature have been conducted to investigate the effects of rTMS on motor function in PD (25–29), while only one systematic review has examined the effects of tDCS on motor outcomes (30). In all five meta-analyses of rTMS literature, the authors found a significant, albeit modest, improvement of motor function following rTMS.…”

Section: Nbs In Pdmentioning

confidence: 99%

Transcranial Alternating Current Stimulation: A Potential Modulator for Pathological Oscillations in Parkinson’s Disease?

et al. 2017

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Low-frequency repetitive transcranial magnetic stimulation on Parkinson motor function: a meta-analysis of randomised controlled trials

Abstract: Low-frequency rTMS had a significant effect on motor signs in PD. As the number of RCTs and PD patients included here was limited, further large-scale multi-center RCTs were required to validate our conclusions.

Cited by 32 publications

References 33 publications

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

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

Non-invasive brain stimulation for Parkinson’s disease: Current concepts and outlook 2015

Transcranial Alternating Current Stimulation: A Potential Modulator for Pathological Oscillations in Parkinson’s Disease?

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