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1.
Alzheimer Dis Assoc Disord ; 33(2): 170-178, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31033517

RESUMO

OBJECTIVE: The purpose of this meta-analysis was to evaluate the therapeutic effect of transcranial direct current stimulation (tDCS) on mild to moderate Alzheimer disease (AD) patients. MATERIALS AND METHODS: PubMed, Embase, Web of Science, and Cochrane Library were searched until April 2018. The primary cognitive outcomes were extracted from included articles. A crude standardized mean difference with 95% CI was calculated by using fixed or random effect models. RESULTS: Seven studies with 146 patients were included in this meta-analysis. The pooled result showed that tDCS significantly improved cognitive function of AD patients (standardized mean difference=0.37; 95% CI, 0.09-0.65; P=0.01). Subgroup analyses showed that: a single session of tDCS was significantly effective (P<0.05) whereas repeated sessions of tDCS was not lower current density (0.06 mA/cm) (P>0.05) but not higher current density (0.08 mA/cm) significantly improved cognitive performance; stimulating the temporal cortex (P<0.05) but not the left dorsal lateral prefrontal cortex significantly improved cognitive function of AD patients; and improved cognitive function occurred in the group with higher education (P<0.05) but not in the group with lower education. CONCLUSIONS: Current evidence suggests that tDCS has a beneficial effect in mild to moderate AD patients. We must be cautious about the results of subgroup analysis given small sample sizes, and further well-designed studies with larger sample size are required to verify these results.

2.
Brain Behav ; 8(11): e01132, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30264518

RESUMO

INTRODUCTION: Therapeutic 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. METHODS: Electronic 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. RESULTS: Twenty-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. CONCLUSIONS: In 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.

3.
Neural Plast ; 2017: 2758097, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29435371

RESUMO

Background and Purpose: This meta-analysis aimed to evaluate the therapeutic potential of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the contralesional hemisphere on upper limb motor recovery and cortex plasticity after stroke. Methods: Databases of PubMed, Medline, ScienceDirect, Cochrane, and Embase were searched for randomized controlled trials published before Jun 31, 2017. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI). Resting motor threshold (rMT) and motor-evoked potential (MEP) were also examined. Results: Twenty-two studies of 1 Hz LF-rTMS over the contralesional hemisphere were included. Significant efficacy was found on finger flexibility (SMD = 0.75), hand strength (SMD = 0.49), and activity dexterity (SMD = 0.32), but not on body function (SMD = 0.29). The positive changes of rMT (SMD = 0.38 for the affected hemisphere and SMD = -0.83 for the unaffected hemisphere) and MEP (SMD = -1.00 for the affected hemisphere and SMD = 0.57 for the unaffected hemisphere) were also significant. Conclusions: LF-rTMS as an add-on therapy significantly improved upper limb functional recovery especially the hand after stroke, probably through rebalanced cortical excitability of both hemispheres. Future studies should determine if LF-rTMS alone or in conjunction with practice/training would be more effective. Clinical Trial Registration Information: This trial is registered with unique identifier CRD42016042181.


Assuntos
Córtex Motor/fisiopatologia , Transtornos dos Movimentos/reabilitação , Plasticidade Neuronal , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Estimulação Magnética Transcraniana , Idoso , Potencial Evocado Motor , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Recuperação de Função Fisiológica , Resultado do Tratamento , Extremidade Superior/fisiopatologia
4.
Clin Rehabil ; 31(3): 289-298, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27113337

RESUMO

OBJECTIVES: A meta-analysis and systematic review was conducted to investigate the potential effects of repetitive transcranial magnetic stimulation on dysphagia in patients with stroke, including different parameters of frequency and stimulation site. METHODS: PubMed, Embase, MEDLINE databases and the Cochrane Library, were searched for randomized controlled studies of repetitive transcranial magnetic stimulation treatment of dysphagia published before March 2016. RESULTS: Six clinical randomized controlled studies of a total of 163 stroke patients were included in this meta-analysis. A significant effect size of 1.24 was found for dysphagic outcome (mean effect size, 1.24; 95% confidence interval (CI), 0.67-1.81). A subgroup analysis based on frequency showed that the clinical scores were significantly improved in dysphagic patients with low frequency repetitive transcranial magnetic stimulation treatment ( P < 0.05) as well as high frequency repetitive transcranial magnetic stimulation treatment ( P < 0.05). A stimulation site stratified subgroup analysis implied significant changes in stroke patients with dysphagia for the unaffected hemisphere ( P < 0.05) and the bilateral hemisphere stimulation ( P < 0.05), but not for the affected hemisphere ( P > 0.05). The analysis of the follow-up data shows that patients in the repetitive transcranial magnetic stimulation groups still maintained the therapeutic benefit of repetitive transcranial magnetic stimulation four weeks after the last session of repetitive transcranial magnetic stimulation therapy ( P < 0.05). CONCLUSION: This meta-analysis indicates that repetitive transcranial magnetic stimulation has a positive effect on dysphagia after stroke. Compared with low-frequency repetitive transcranial magnetic stimulation, high-frequency repetitive transcranial magnetic stimulation may be more beneficial to the patients. This meta-analysis also supports that repetitive transcranial magnetic stimulation on an unaffected - or bilateral - hemisphere has a significant therapeutic effect on dysphagia.


Assuntos
Transtornos de Deglutição/terapia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Estimulação Magnética Transcraniana/métodos , Transtornos de Deglutição/etiologia , Humanos , Resultado do Tratamento
5.
Neural Plast ; 2016: 6238575, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27840742

RESUMO

Purpose. The aim of this study was to evaluate the effects of high frequency repetitive transcranial magnetic stimulation (HF-rTMS) on stroke patients with motor dysfunction and to investigate the underlying neural mechanism. Methods. Fifteen stroke patients were assigned to the rTMS treatment (RT) group and conventional treatment (CT) group. Patients in the RT received 10 Hz rTMS stimulation on the ipsilesional primary motor cortex for 10 days plus conventional treatment of CT, which consisted of acupuncture and antiplatelet aggregation medication. Difference in fractional anisotropy (FA) between pretreatment and posttreatment and between two groups was determined. Correlations between FA values and neurological assessments were also calculated. Results. Both groups significantly improved the neurological function after treatment. rTMS-treated patients showed better improvement in Fugl-Meyer Assessment (FMA) score and increased FA value in motor-related white matter and gray matter cortices compared with CT-treated patients and pretreatment status. Besides, the increased FA value in the ipsilesional posterior limb of the internal capsule in RT group was significantly correlated with the improved FMA score. Significance. HF-rTMS could be a supplement therapy to CT in improving motor recovery in patients with stroke. And this benefit effect may be achieved through modulating the ipsilesional corticospinal tracts and motor-related gray matter cortices.


Assuntos
Lateralidade Funcional/fisiologia , Transtornos Motores/etiologia , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/terapia , Estimulação Magnética Transcraniana , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Transtornos Motores/fisiopatologia , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Magnética Transcraniana/métodos , Resultado do Tratamento
6.
Neuroreport ; 27(4): 284-8, 2016 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-26825348

RESUMO

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive treatment tool for the recovery of cerebral palsy (CP). This report describes the modulation effect of rTMS to functional connectivity, functional network connectivity, motor, and cognitive ability following treatment in a child with mild ataxia CP. After receiving 8 months of 0.5 Hz rTMS treatment over the right dorsolateral prefrontal cortex, the child showed a gradual improvement in motor and cognitive-related functional connectivity and functional network connectivity following treatment as well as improved motor, cognitive functions. These pilot results provide the first evidence of the efficiency of 0.5 Hz of rTMS on a child with CP. Further large sample studies are needed to verify and expand the present findings.


Assuntos
Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/reabilitação , Córtex Pré-Frontal/fisiopatologia , Estimulação Magnética Transcraniana/métodos , Paralisia Cerebral/psicologia , Criança , Cognição/fisiologia , Humanos , Masculino , Atividade Motora/fisiologia , Vias Neurais/fisiopatologia , Projetos Piloto , Resultado do Tratamento
7.
BMC Psychiatry ; 15: 282, 2015 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-26573324

RESUMO

BACKGROUND: Sleep deprivation (SD) and repetitive transcranial magnetic stimulation (rTMS) have been commonly used to treat depression. Recent studies suggest that co-therapy with rTMS and SD may produce better therapeutic effects than either therapy alone. Therefore, this study was to review the current findings to determine if rTMS can augment the therapeutic effects of SD on depression. METHODS: Embase, JSTOR, Medline, PubMed, ScienceDirect, and the Cochrane Central Register of Controlled Trials were searched for clinical studies published between January 1985 and March 2015 using the search term "rTMS/repetitive transcranial magnetic stimulation AND sleep deprivation AND depress*". Only randomized and sham-controlled trials (RCTs) involving the combined use of rTMS and SD in depression patients were included in this systematic review. The scores of the Hamilton Rating Scale for Depression were extracted as primary outcome measures. RESULTS: Three RCTs with 72 patients that met the inclusion criteria were included for the systematic review. One of the trials reported skewed data and was described alone. The other two studies, which involved 30 patients in the experimental group (SD + active rTMS) and 22 patients in the control group (SD + sham rTMS), reported normally distributed data. The primary outcome measures showed different results among the three publications: two of which showed great difference between the experimental and the control subjects, and the other one showed non-significant antidepressant effect of rTMS on SD. In addition, two of the included studies reported secondary outcome measures with Clinical Global Impression Rating Scale and a self-reported well-being scale which presented good improvement for the depressive patients in the experiment group when compared with the control. The follow-up assessments in two studies indicated maintained results with the immediate measurements. CONCLUSIONS: From this study, an overview of the publications concerning the combined use of rTMS and SD is presented, which provides a direction for future research of therapies for depression. More studies are needed to confirm whether there is an augmentative antidepressant effect of rTMS on SD.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo/terapia , Sono , Adolescente , Adulto , Idoso , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Autorrelato , Estimulação Magnética Transcraniana/métodos , Resultado do Tratamento , Adulto Jovem
8.
Pain Physician ; 18(6): E1029-46, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26606017

RESUMO

BACKGROUND: Increasing evidence supports an analgesic effect of repetitive transcranial magnetic stimulation (rTMS) for neuropathic pain (NP). However, the optimal parameters of rTMS (stimulation frequency and treatment sessions) for achieving long-term analgesic effects remain unknown. This study analyzed the current findings in the literature. OBJECTIVE: The aim of this study was to assess the optimal parameters of rTMS for NP, including the rTMS sessions needed for inducing acute as well as long-term analgesic effects. STUDY DESIGN: A meta-analysis of the analgesic effect of high frequency rTMS (HF- rTMS) for neuropathic patients. SETTING: This meta-analysis examined all studies involving the analgesic efficacy of HF-rTMS for NP. METHODS: PubMed, Embase, and the Cochrane library were searched for clinical studies of rTMS treatment on NP published before December 31, 2014. Crude standardized mean differences (SMD) with 95% confidence interval (CI) were calculated for pain intensity after different treatment sessions (from 1 to 10) and follow-up of one or 2 months after rTMS treatment using random effect models. RESULTS: Twenty-five studies (including 32 trials and 589 patients) were selected for the meta-analysis according to the inclusion and exclusion criteria. All 3 HF-rTMS treatments (5, 10, and 20 Hz) produced pain reduction, while there were no differences between them, with the maximal pain reduction found after one and 5 sessions of rTMS treatment. Further, this significant analgesic effect remained forone month after 5 sessions of rTMS treatment. LIMITATIONS: There are limitations of this meta-analysis. For example, the long-term analgesic effects of different HF-rTMS and low frequency (LF) rTMS sessions, including the single session of rTMS on different NP of varying origins have yet not been evaluated; the full degree of pain relief is still unclear for many rTMS studies. CONCLUSIONS: HF-rTMS stimulation on primary motor cortex is effective in relieving pain in NP patients. Although 5 sessions of rTMS treatment produced a maximal analgesic effect and may be maintained for at least one month, further large-scale and well-controlled trials are needed to determine if this enhanced effect is specific to certain types of NP such as post-stroke related central NP.


Assuntos
Dor Crônica/terapia , Neuralgia/terapia , Manejo da Dor/métodos , Estimulação Magnética Transcraniana/métodos , Dor Crônica/diagnóstico , Dor Crônica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/diagnóstico , Neuralgia/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
9.
Neurosci Biobehav Rev ; 57: 392-400, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26344667

RESUMO

BACKGROUND: Functional magnetic resonance imaging (fMRI) studies suggest that stroke-induced motor deficits are associated with an interhemispheric imbalance of motor activation. This meta-analysis aims to determine the changes of interhemispheric activation balance (IHAB) in motor-related cortices along with post-stroke motor recovery. METHODS: We searched PubMed for fMRI studies that investigated IHAB in stroke patients with motor recovery. Laterality indexes (LIs, (ipsilesional activation-contralesional activation)/(ipsilesional activation+contralesional activation)) before and after motor improvement were extracted as the outcome measures of IHAB. Data were synthesized by calculating standardized mean difference (SMD, Hedges' adjusted g) with 95% confidence intervals (CI). RESULTS: After the rejection of 459 studies, 22 trials fulfilled the inclusion criteria and were included in the systematic review and meta-analysis. The LIs of sensorimotor cortex (SMC, 22 trials, 195 subjects), premotor cortex (PMC, 12 trials, 93 subjects), supplementary motor area (SMA, 12 trials, 92 subjects), and cerebellum (CB, 4 trials, 31 subjects) were assessed. Studies sampling from stroke patients with motor improvement showed positive changes of LI in SMC (SMD, 0.71; 95% CI, 0.41-1.01; P<0.00001) and PMC (SMD, 0.68; 95% CI, 0.36-1.00; P<0.0001), but not in SMA (SMD, 0.07; 95% CI, -0.62 to 0.75; P=0.85) and CB (SMD, -0.17; 95% CI, -1.52 to 1.19, P=0.81). Studies involving stroke patients with poor motor recovery showed non-significant changes in all of the four motor-related cortices (P>0.05). CONCLUSIONS: This meta-analysis suggests that along with good motor recovery of stroke patients, the IHAB is up-regulated in SMC and PMC, but not significantly changed in SMA and CB. Because of the limited data, further studies are needed to verify the findings.


Assuntos
Córtex Cerebelar/fisiopatologia , Córtex Cerebral/fisiopatologia , Imagem por Ressonância Magnética/estatística & dados numéricos , Transtornos dos Movimentos , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral , Humanos , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/fisiopatologia , Transtornos dos Movimentos/reabilitação , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral
10.
J Alzheimers Dis ; 48(2): 463-72, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26402010

RESUMO

BACKGROUND: Recent studies have indicated that repetitive transcranial magnetic stimulation (rTMS) could improve cognitive function in people with Alzheimer's disease (AD). Yet the results are inconclusive. OBJECTIVE: This meta-analysis aimed to evaluate recent rTMS studies conducted in mild to moderate AD patients. METHODS: PubMed, Embase, MEDLINE databases and Science Direct were searched for studies of rTMS treatment on AD patients with cognitive impairment published before February 2015. The relevant primary outcomes of cognition were extracted from those included studies. A crude standardized mean difference (SMD) with 95% confidence interval (CI) was calculated by using random effect models. RESULTS: Seven studies with a total of 94 mild to moderate AD patients were included in this meta-analysis. A significant overall rTMS treatment effect on cognition was found for all AD patients (p = 0.0008, SMD = 1.00, 95% CI = 0.41-1.58). Stratification analysis showed that this effect is stimulation frequency- and hemisphere-dependent. High frequency stimulation (>1.0 Hz) (p <  0.05) but not low frequency stimulation (≤1.0 Hz) (p >  0.05) was significantly effective in improving the cognition of AD patients. Further, rTMS stimulation on right dorsolateral prefrontal cortex (DLPFC) and bilateral DLPFC (p <  0.05), but not on the left DLPFC (p >  0.05) was significantly effective in improving cognitive function of AD patients. A significant effect was observed in the rTMS subgroup (p <  0.05), rather than in the rTMS+drug subgroup (p >  0.05). CONCLUSION: This meta-analysis supports that high frequency rTMS stimulation on right- or bilateral-DLPFC has significant therapeutic effect on cognitive function in patients with mild to moderate AD. Due to small number of studies included, more well-controlled rTMS studies should be evaluated in AD patients in the future.


Assuntos
Doença de Alzheimer/terapia , Transtornos Cognitivos/terapia , Estimulação Magnética Transcraniana , Doença de Alzheimer/complicações , Doença de Alzheimer/fisiopatologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/fisiopatologia , Humanos , Estimulação Magnética Transcraniana/métodos
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