Treatment of upper limb spasticity with inhibitory repetitive transcranial magnetic stimulation: A randomized placebo-controlled trial

Gottlieb, Anna; Boltzmann, Melanie; Schmidt, Simone; Gütenbrunner, Christoph; Krauss, Joachim K.; Stangel, Martin; Höglinger, Günter U.; Wallesch, Claus‐W.; Rollnik, Jens D.

doi:10.3233/nre-210088

Cited by 18 publications

(23 citation statements)

References 24 publications

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“…Through the final full-text review, 14 articles were ultimately included for this review. This study included eight research articles [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] on rTMS, one of which included three data sets, one article included two data sets and the other articles each had one data set. A total of 128 patients received rTMS in all studies, and 104 patients served as the control group.…”

Section: Resultsmentioning

confidence: 99%

“…In the studies included in this meta-analysis, most of the brain regions stimulated by NIBS were the primary motor cortex [ 22 , 27 , 28 , 30 ], and a few studies were stimulated in the premotor cortex [ 23 , 30 ] and cerebellum [ 40 ]. The premotor cortex plays an important role in motor control and is another stimulation target besides the primary motor cortex [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

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Effects of Non-Invasive Brain Stimulation on Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Wang

Liu

et al. 2022

Brain Sciences

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In recent years, the potential of non-invasive brain stimulation (NIBS) for the therapeutic effect of post-stroke spasticity has been explored. There are various NIBS methods depending on the stimulation modality, site and parameters. The purpose of this study is to evaluate the efficacy of NIBS on spasticity in patients after stroke. This systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. PUBMED (MEDLINE), Web of Science, Cochrane Library and Excerpta Medica Database (EMBASE) were searched for all randomized controlled trials (RCTs) published before December 2021. Two independent researchers screened relevant articles and extracted data. This meta-analysis included 14 articles, and all included articles included 18 RCT datasets. The results showed that repetitive transcranial magnetic stimulation (rTMS) (MD = −0.40, [95% CI]: −0.56 to −0.25, p < 0.01) had a significant effect on improving spasticity, in which low-frequency rTMS (LF-rTMS) (MD = −0.51, [95% CI]: −0.78 to −0.24, p < 0.01) and stimulation of the unaffected hemisphere (MD = −0.58, [95% CI]: −0.80 to −0.36, p < 0.01) were beneficial on Modified Ashworth Scale (MAS) in patients with post-stroke spasticity. Transcranial direct current stimulation (tDCS) (MD = −0.65, [95% CI]: −1.07 to −0.22, p < 0.01) also had a significant impact on post-stroke rehabilitation, with anodal stimulation (MD = −0.74, [95% CI]: −1.35 to −0.13, p < 0.05) being more effective in improving spasticity in patients. This meta-analysis revealed moderate evidence that NIBS reduces spasticity after stroke and may promote recovery in stroke survivors. Future studies investigating the mechanisms of NIBS in addressing spasticity are warranted to further support the clinical application of NIBS in post-stroke spasticity.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of Non-Invasive Brain Stimulation on Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Wang

Liu

et al. 2022

Brain Sciences

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“…The efficacy of some pharmacological agents (e.g., monoaminergic drugs) that have an impact on motor cortex excitability and plasticity could be investigated [ 19 ]. The neuromodulation of M1 using non-invasive techniques such as transcranial direct current stimulation (tDCS) or transcranial magnetic stimulation (TMS) has also shown some promising results and should also be further assessed [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Changes of Spasticity across Time in Prolonged Disorders of Consciousness: A Retrospective Study

Winters

Kuluris²,

Pathmanaban³

et al. 2022

Brain Sciences

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Objectives: In this retrospective study, we investigated how spasticity developed in patients diagnosed with a prolonged DOC over an almost two-year observation period (21 months), and how it related to the patients’ age, gender, time since injury, etiology, level of consciousness, and anti-spastic medications. Methods: In total, 19 patients with a severe brain injury and prolonged DOC admitted to a long-term care facility were included in this study (14 male, age: 45.8 ± 15.3 years, 10 traumatic brain injury, 1.01 ± 0.99 years after brain injury, 11 minimally conscious state vs. 8 vegetative state). Each patient was assessed at admission and then quarterly, totaling eight assessments over 21 months. Spasticity was measured with the Modified Ashworth Scale (MAS) for both upper and lower limbs. The Western Neuro Sensory Stimulation Profile (WNSSP) was administered to assess the level of consciousness. Any other medical and demographic information of interest was obtained through medical records. Linear mixed models were used to assess each variable’s impact on the change of spasticity over time. Results: Significant differences were observed in the evolution of spasticity in patients based on their etiology for the upper limbs [F (7, 107.29) = 2.226; p = 0.038], and on their level of consciousness for the lower limbs [F (7, 107.07) = 3.196; p = 0.004]. Conclusion: Our preliminary results suggest that spasticity evolves differently according to the type of brain lesion and the level of consciousness. Spasticity in DOCs might therefore be mediated by different mechanisms and might have to be treated differently among patients. Future longitudinal studies should be performed prospectively in a bigger cohort and with data collection beginning earlier after brain injury to confirm our results and better understand the evolution of spasticity in this population.

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“…The characteristics of the included studies are shown in Table 1. 10.3389/fncir.2022.973561 Zhang et al, 2020;Gottlieb et al, 2021;Mendonca et al, 2021;Xu R. et al, 2021;Yang, 2021;Zhao, 2021;Cheng et al, 2022;Xia et al, 2022b;Yang and Yang, 2022;Zang et al, 2022) was rated as "high risk of bias" and twelve studies (Valle et al, 2007;Benito et al, 2012;Liao et al, 2015;Askin et al, 2017;Qin et al, 2018a,b;Watanabe et al, 2018;Korzhova et al, 2019;Liu et al, 2019;Chen et al, 2021;Liang et al, 2021;Xia et al, 2022a) were considered as "some concerns. "…”

Section: The Characteristics Of Included Studiesmentioning

confidence: 99%

“…Among forty-two included studies, eleven studies (Valle et al, 2007;Yan, 2015;Askin et al, 2017;Li, 2017;Kong, 2018;Tao and Wei, 2018;Dos Santos et al, 2019;Qi, 2020;Chen et al, 2021;Mendonca et al, 2021;Xu R. et al, 2021) reported that all patients could tolerate rTMS without complications, and no serious adverse effects were occurred. Seven studies (Kumru et al, 2010(Kumru et al, , 2016Benito et al, 2012;Luo, 2020;Gottlieb et al, 2021;Xia et al, 2022a,b) described that 33 patients complained of twitching facial muscles, headache, pain in contralateral hand, dizziness, neck pain, and mild drowsiness after the rTMS treatment. The rest studies did not mention any adverse effects during rTMS treatment.…”

Section: Adverse Eventsmentioning

confidence: 99%

The effectiveness and safety of repetitive transcranial magnetic stimulation on spasticity after upper motor neuron injury: A systematic review and meta-analysis

Fan

Fu²,

Xie³

et al. 2022

Front. Neural Circuits

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To systematically evaluate the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) on spasticity after upper motor neuron (UMN) injury. Eight electronic databases were searched from inception to August 6, 2022. Randomized controlled trials (RCTs) investigating the effectiveness and safety of rTMS on spasticity after UMN injury were retrieved. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Review Manager 5.3 and Stata 14.0 software were used to synthesize data. The certainty of the evidence was appraised with the Grade of Recommendation, Assessment, Development and Evaluation tool. Forty-two studies with a total of 2,108 patients were included. The results of meta-analysis revealed that, compared with control group, rTMS could significantly decrease scores of the Modified Ashworth Scale (MAS) in patients with UMN injury. The subgroup analysis discovered that rTMS effectively decreased the MAS scores in patients with stroke. Meanwhile, rTMS treatment > 10 sessions has better effect and rTMS could decrease the MAS scores of upper limb. Thirty-three patients complained of twitching facial muscles, headache and dizziness, etc. In summary, rTMS could be recommended as an effective and safe therapy to relieve spasticity in patients with UMN injury. However, due to high heterogeneity and limited RCTs, this conclusion should be treated with caution.

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Treatment of upper limb spasticity with inhibitory repetitive transcranial magnetic stimulation: A randomized placebo-controlled trial

Cited by 18 publications

References 24 publications

Effects of Non-Invasive Brain Stimulation on Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Effects of Non-Invasive Brain Stimulation on Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Changes of Spasticity across Time in Prolonged Disorders of Consciousness: A Retrospective Study

The effectiveness and safety of repetitive transcranial magnetic stimulation on spasticity after upper motor neuron injury: A systematic review and meta-analysis

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