Effects of Cerebellar Transcranial Magnetic Stimulation on the Motor Function of Patients With Stroke: A Systematic Review and Meta-Analysis

IF 2.6 3区心理学 Q2 BEHAVIORAL SCIENCES

Brain and Behavior Pub Date : 2025-04-18 DOI:10.1002/brb3.70471

Yongxin Zhu, Juncong Yang, Kun Wang, Xianwen Li, Jiahui Ling, Xie Wu, Lianhui Fu, Qi Qi

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引用次数: 0

Abstract

Background

As the core of motor control and learning, the cerebellum is crucial for maintaining posture, regulating muscle tone, and coordinating movement. In recent years, there has been an increase in the number of studies on the application of cerebellar transcranial magnetic stimulation (cTMS) to motor dysfunction in patients with stroke. This review aims to analyze cTMS efficacy for stroke patients and further explore the specific effects of different stages of the disease, stimulation modes, stimulation intensity, and treatment duration.

Methods

Six databases were searched comprehensively—CNKI, Wanfang, Web of Science, PubMed, The Cochrane Library, and Embase—to collect randomized controlled trials (RCTs) up to October 2024 that investigated the improvement of physical motor dysfunction in stroke patients using cTMS. Two researchers screened the literature, extracted data, and independently assessed the quality and risk of bias of the included studies using the PEDro scale and the Cochrane Risk of Bias Assessment Tool 2. Meta-analysis was performed using RevMan 5.4.

Results

A total of 20 RCTs with 812 participants were included. Meta-analysis and sensitivity analysis revealed that cTMS significantly improved BBS (Random, MD = 5.19, 95%CI = 3.66–6.72, p < 0.00001), enhanced FMA-LE scores (Random, MD = 1.88, 95%CI = 0.76–3.01, p = 0.001), shortened the TUG (Fix, MD = −1.64, 95%CI = −2.60 to −0.68, p = 0.0008), and 10MWT durations (Fix, MD = −7.66, 95%CI = −12.33 to −2.99, p = 0.001), and increased MEP amplitudes (Fix, MD = 0.45, 95%CI = 0.04–0.87, p = 0.03). Subgroup analysis of the BBS showed that cTMS had a significant effect on patients with stroke in the subacute phase (p < 0.00001), with improvements observed using HF-rTMS (p < 0.0001), iTBS (p < 0.00001), and intensities ≤ 80%RMT (< 80% RMT, p < 0.0001; 80% RMT, p < 0.00001). cTMS consistently demonstrated superior effects compared to controls across different intervention durations (5–10 sessions, p = 0.009; 11–20 sessions, p < 0.00001; > 20 sessions, p < 0.00001).

Conclusion

cTMS effectively improves motor function in patients with stroke, particularly during the subacute phase with excitatory stimulation and moderate intensities (≤ 80%RMT).

Trial Registration

PROSPERO number: CRD42024540604

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经颅磁刺激对脑卒中患者运动功能的影响：系统回顾和meta分析

小脑作为运动控制和学习的核心，在保持姿势、调节肌肉张力和协调运动方面起着至关重要的作用。近年来，应用经颅磁刺激（cTMS）治疗脑卒中患者运动功能障碍的研究越来越多。本综述旨在分析cTMS对脑卒中患者的疗效，并进一步探讨不同疾病阶段、刺激方式、刺激强度和治疗时间的具体效果。方法综合检索中国知网（cnki）、万方网（Wanfang）、Web of Science、PubMed、The Cochrane Library和embase 6个数据库，收集截至2024年10月的随机对照试验（RCTs），研究cTMS对脑卒中患者身体运动功能障碍的改善。两名研究人员筛选文献，提取数据，并使用PEDro量表和Cochrane偏倚风险评估工具2独立评估纳入研究的质量和偏倚风险。采用RevMan 5.4进行meta分析。结果共纳入20项随机对照试验，812名受试者。meta分析和敏感性分析显示，cTMS显著改善了BBS(随机，MD = 5.19, 95%CI = 3.66-6.72, p <；0.00001)，增强FMA-LE评分（Random, MD = 1.88, 95%CI = 0.76-3.01, p = 0.001），缩短TUG （Fix, MD = - 1.64, 95%CI = - 2.60 - - 0.68, p = 0.0008）和10MWT持续时间（Fix, MD = - 7.66, 95%CI = - 12.33 - - 2.99, p = 0.001），增加MEP振幅（Fix, MD = 0.45, 95%CI = 0.04-0.87, p = 0.03）。BBS的亚组分析显示，cTMS对亚急性期脑卒中患者有显著影响(p <；0.00001)，使用HF-rTMS观察到改善(p <；0.0001), iTBS (p <；0.00001)，强度≤80%RMT (<；80% RMT, p <；0.0001;80% RMT, p <；0.00001)。与对照组相比，cTMS在不同干预持续时间(5-10次，p = 0.009；11-20节，p <；0.00001;比;20次会议，p <；0.00001)。结论cTMS可有效改善脑卒中患者的运动功能，特别是在亚急性期兴奋性刺激和中等强度（≤80%RMT）时。试验注册号：CRD42024540604

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来源期刊

Brain and Behavior BEHAVIORAL SCIENCES-NEUROSCIENCES

CiteScore

5.30

自引率

0.00%

发文量

352

审稿时长

14 weeks

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