Therapeutic effects of repetitive transcranial magnetic stimulation on cognitive impairment in stroke patients: a systematic review and meta-analysis

Abstract

BackgroundIn recent years, repetitive transcranial magnetic stimulation (rTMS) has emerged as a noninvasive and painless treatment for post-stroke cognitive impairment (PSCI). However, few studies have analyzed the intervention parameters of cognitive function and the effectiveness and safety of rTMS for treating patients with PSCI. Thus, this meta-analysis aimed to analyze the interventional parameters of rTMS and evaluate the safety and effectiveness of rTMS for treating patients with PSCI.MethodsAccording to the PRISMA guidelines, we searched the Web of Science, PubMed, EBSCO, Cochrane Library, PEDro, and Embase to retrieve randomized controlled trials (RCTs) of rTMS for the treatment of patients with PSCI. Studies were screened according to the inclusion and exclusion criteria, and two reviewers independently performed literature screening, data extraction, and quality assessment. RevMan 5.40 software was used for data analysis.Results12 RCTs involving 497 patients with PSCI met the inclusion criteria. In our analysis, rTMS had a positive therapeutic effect on cognitive rehabilitation in patients with PSCI (P < 0.05). Both high-frequency rTMS and low-frequency rTMS were effective in improving the cognitive function of patients with PSCI by stimulating the dorsolateral prefrontal cortex (DLPFC), but their efficacy was not statistically different (P > 0.05).ConclusionsrTMS treatment on the DLPFC can improve cognitive function in patients with PSCI. There is no significant difference in the treatment effect of high-frequency rTMS and low-frequency rTMS in patients with PSCI between high-frequency and low-frequency rTMS.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323720, identifier CRD 42022323720.

Efficacy of repetitive transcranial magnetic stimulation in post-stroke cognitive impairment: an overview of systematic reviews

“…MMSE, MoCA, BI, MBI, RBMT, and LOTCA were among the primary outcome indicators used. Thirteen ( 31–41 , 43 , 47 ) articles reported financial support. Most studies concluded that rTMS has advantages in treating PSCI but emphasized the need for more, higher-quality studies to validate the results.…”

“…Therefore, the literature rankings published in 2023 were positioned as 17. The earliest publication date is 2021, containing five ( 31 , 33 , 34 , 42 , 46 ) studies; the latest is 2023, containing 10 ( 32 , 36–40 , 43–45 , 47 ). Meanwhile, there were two ( 35 , 41 ) studies in 2022.…”

“…The vital entries reported as missing in large numbers are entry 2 (41%), entry 7 (0%), entry 13 (12%), and entry 15 (41%). The following were the primary causes: (1) only seven ( 36–38 , 40 , 43 , 46 , 47 ) articles were numbered and registered in the program before the evaluation; (2) the reasons for the exclusion list are not provided in all the articles; (3) only two ( 40 , 46 ) articles considered the risk of study bias when discussing or analyzing the results of each study; (4) all articles were searched without consulting experts in the relevant fields; and (5) 10 ( 31 , 33 , 36 , 39–44 , 47 ) articles do not describe the likelihood of the existence of publication bias in the small-sample studies and the severity of their impacts. The non-vital entries reported as missing in large numbers are entry 3 (0%), entry 10 (0%), entry 12 (29%), and entry 14 (47%).…”

“…Seventeen articles had a score ranging from 5 to 11. Among them, three ( 33 , 42 , 44 ) studies scored 5, one ( 31 ) literature scored 6, one ( 41 ) literature scored 6.5, four ( 35 , 39 , 43 , 45 ) articles scored 7, one ( 34 ) literature scored 8, one ( 37 ) literature scored 9, three ( 32 , 36 , 40 ) articles scored 10, and three ( 38 , 46 , 47 ) articles scored 11. Refer to Table 2 for details.…”

“…Thirteen studies included in the analysis ( 31–34 , 36 , 38–41 , 43 , 45–47 ) mentioned the occurrence of adverse effects following rTMS therapy. The frequently mentioned adverse effects were mild headache, dizziness, nausea, and vomiting, as well as other effects, including loss of appetite, anxiety, and fatigue.…”