Objective To evaluate the systematic reviews of repetitive transcranial magnetic stimulation (rTMS) for insomnia, to provide supporting evidence for clinical practice. Methods PubMed, Embase, Web of Science, Cochrane Library, Elsevier Science Direct, China National Knowledge Infrastructure, SinoMed, Wanfang and Chongqing VIP were searched from databases establishment to May 30, 2022, to find systematic reviews on the treatment of insomnia with rTMS as the main method. The methodological quality, reporting quality and evidence quality of outcome indicators were evaluated by AMSTAR 2, PRISMA 2020 and GRADE. Results A total of 4 systematic reviews published between 2018 and 2021 were included. Further analysis showed that one of the systematic reviews had a low AMSTAR 2 quality rating and the remaining systematic reviews were very low. The average PRISMA 2020 score of these 4 systematic reviews was (20.75±3.27) points, of which 3 systematic reviews had some defects in their reports, and the other one had relatively complete reports. The GRADE evidence quality assessment showed that there were 40 outcome indicators in the included literature, of which 3 outcome indicators (sleep quality, the percentage of S2 sleep in total sleep time, and S3 sleep in percentage of total sleep time) were rated as moderate, 17 were rated as low and 20 were rated as very low. Conclusions The treatment of insomnia by rTMS has achieved certain effects in clinical practice, but the systematic review of rTMS as the main intervention measure for insomnia needs to further improve the quality and standardize related research. The clinical application of rTMS for insomnia should be treated as appropriate.
ObjectiveTo observe the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) applied at contralesional hemisphere Broca’s homologue on patients with global aphasia after left massive cerebral infarction. Methods Patients with global aphasia after left massive cerebral infarction in the Department of Neurorehabilitation of China Rehabilitation Research Center between August 2021 and December 2023 were selected. According to the random number table method, patients were randomly divided into a low-frequency rTMS group and a high-frequency rTMS group. rTMS targeted the mirror area within the right hemispheric Broca’s area. Patients’ language ability was assessed pre- and post-treatment by the Chinese version of the western aphasia battery (WAB). Results A total of 27 patients were included, with 14 in the low-frequency rTMS group and 13 in the high-frequency rTMS group. Before treatment, there was no statistically significant difference in the WAB test indicators between the two groups of patients (P>0.05). After treatment, WAB scores (spontaneous speech, auditory comprehension, naming, repetition, aphasia quotients) in both groups were significantly improved (P<0.05); compared to the low-frequency rTMS group, the high-frequency rTMS group exhibited significant improvement in spontaneous speech, auditory comprehension, repetition, naming and aphasia quotients (P<0.05). Conclusion The effect of high-frequency rTMS excitation to contralesional hemisphere is better than that of conventional low-frequency rTMS inhibition to contralesional hemisphere in improving the speech function of patients with global aphasia after left massive cerebral infarction.
ObjectiveTo systematically review the efficacy of different stimulation modalities of repetitive transcranial magnetic stimulation (rTMS) combined with SSRI in improving depressed mood after stroke using network meta-analysis. MethodsThe PubMed, EMbase, Cochrane Library, Web of Science, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to October 1, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Network meta-analysis was then performed by using R 4.2.1software. ResultsA total of 25 RCTs involving 2 152 patients were included. Four types of rTMS stimulation combined with SSRIs were included: high-frequency stimulation of the left dorsolateral prefrontal (l-DLPFC), low-frequency stimulation of l-DLPFC, low-frequency stimulation of the right dorsolateral prefrontal (r-DLPFC), and low-frequency stimulation of the bilateral DLPFC. The results of the network meta-analysis showed that the effect of combining four stimulation methods with SSRI in treating depression was better than that of SSRI alone (P<0.05). Probability sorting results showed that low-frequency stimulated bilateral DLPFC (88.9%) > low-frequency stimulated l-DLPFC (63.1%) > high-frequency stimulation l-DLPFC (57.1%) > low-frequency stimulation r-DLPFC (40.4%). There was no statistically significant difference in the incidence of adverse reactions between the four stimulation methods combined with SSRI and the use of SSRI alone (P>0.05). Conclusion?rTMS combined with SSRIs is better than SSRIs alone in improving depressed mood after stroke. Low-frequency rTMS stimulation of bilateral DLPFC may be the best. Meanwhile, the safety of different stimulation methods is good.
ObjectiveTo investigate the efficacy of transcranial combined with peripheral repetitive magnetic stimulation on motor dysfunction after stroke.MethodsA total of 40 patients after stroke who were hospitalized in the Department of Rehabilitation Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University between January and December 2019 were selected. The patients were divided into the trial group and the control group by random number table method, with 20 cases in each group. Both groups received conventional rehabilitation and medicine treatment, on that basis, the trial group received repetitive transcranial magnetic stimulation (rTMS) combined with repetitive peripheral magnetic stimulation (rPMS), while the control group received rTMS combined with fake rPMS, both lasted for 2 weeks. Before treatment and 2, 4, 12 weeks after the initiation of treatment, the Fugl-Meyer Assessment (FMA) [including FMA-Upper Limb (FMA-UL), FMA-Lower Limb (FMA-LL)], National Institute of Health Stroke Scale (NIHSS), and Modified Barthel Index (MBI) were used to evaluate the efficacy of rTMS combined with rPMS.ResultsFive patients fell off, and 35 patients were finally included, including 18 in the trial group and 17 in the control group. No adverse reaction occurred during the study. Before treatment, there was no significant difference in FMA, FMA-UL, FMA-LL, NIHSS or MBI scores between the two groups (P>0.05). After treatment, the FMA score of the trial group changed from 36.44±28.59 to 75.56±19.94, and that of the control group changed from 39.05±29.85 to 54.64±23.25; the between-group difference was statistically significant at the end of the 4th and 12th weeks (P<0.05). The FMA-UL score of the trial group changed from 21.39±22.14 to 46.94±15.84, and that of the control group changed from 20.82±20.47 to 31.29±16.98; the between-group difference was statistically significant at the end of the 4th and 12th weeks (P<0.05). The FMA-LL score of the trial group changed from 15.06±9.10 to 28.61±5.69, and that of the control group changed from 18.23±10.33 to 23.35±8.20; the between-group difference was statistically significant at the end of the 12th week (P>0.05). The NIHSS score of the trial group changed from 6.83±4.54 to 2.78±2.05, and that of the control group changed from 6.35±3.67 to 3.94±2.56; the MBI score of the trial group changed from 53.33±17.90 to 83.06±12.50, and that of the control group changed from 60.88±25.45 to 78.82±15.67; there was no statistically significant difference in NIHSS or MBI between the two groups at any timepoint (P>0.05). Except for the FMA-LL of the control group, the other outcome indicators in each group were significantly different after treatment compared with those before treatment (P<0.05).ConclusionsBoth rTMS and rTMS combined with rPMS can improve the limb motor function and activities of daily living of stroke patients. The treatment mode of rTMS combined with rPMS has better effect on motor dysfunction after stroke, which is of great significance for improving the overall rehabilitation effect.
ObjectiveTo systematically review the effects of repetitive transcranial magnetic stimulation (rTMS) on stroke patients with aphasia. MethodsDatabases such as PubMed, EMbase, The Cochrane Library (Issue 6, 2014), CBM, CNKI, WanFang Data were searched up to June 2014, for randomized controlled trials (RCTs) about rTMS for stroke patients with aphasia. Two reviewers independently screened literature according to the exclusion and inclusion criteria, extracted data and assessed methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 9 RCTs involving 130 patients were included. The results of meta-analysis showed that compared with the control group, rTMS improved stoke patients' speech function after treatment (WMD=14.36, 95%CI 6.93 to 21.79, P=0.000 2). The results of descriptive analysis showed that, rTMS at Broadmann area 45 (1 Hz, 90% RMT, once 20 or 30 minutes, 2 or 3 weeks as a course with 2-day intervals) possibly had a positive long-term effect on post-stroke patients' speech function. ConclusionrTMS may positively improve stroke patients' speech function. Due to limited quantity and quality of the included studies, more large-scale, multicenter, high quality RCTs are needed to verify the above conclusion.
Weightlessness in the space environment affects astronauts’ learning memory and cognitive function. Repetitive transcranial magnetic stimulation has been shown to be effective in improving cognitive dysfunction. In this study, we investigated the effects of repetitive transcranial magnetic stimulation on neural excitability and ion channels in simulated weightlessness mice from a neurophysiological perspective. Young C57 mice were divided into control, hindlimb unloading and magnetic stimulation groups. The mice in the hindlimb unloading and magnetic stimulation groups were treated with hindlimb unloading for 14 days to establish a simulated weightlessness model, while the mice in the magnetic stimulation group were subjected to 14 days of repetitive transcranial magnetic stimulation. Using isolated brain slice patch clamp experiments, the relevant indexes of action potential and the kinetic property changes of voltage-gated sodium and potassium channels were detected to analyze the excitability of neurons and their ion channel mechanisms. The results showed that the behavioral cognitive ability and neuronal excitability of the mice decreased significantly with hindlimb unloading. Repetitive transcranial magnetic stimulation could significantly improve the cognitive impairment and neuroelectrophysiological indexes of the hindlimb unloading mice. Repetitive transcranial magnetic stimulation may change the activation, inactivation and reactivation process of sodium and potassium ion channels by promoting sodium ion outflow and inhibiting potassium ion, and affect the dynamic characteristics of ion channels, so as to enhance the excitability of single neurons and improve the cognitive damage and spatial memory ability of hindlimb unloading mice.
Parkinson’s disease is a neurodegenerative disease that mostly occurs in middle-aged and elderly people. It is characterized by progressive loss of dopaminergic neurons in the substantia nigra and aggregation of Lewy bodies, resulting in a series of motor symptoms and non-motor symptoms. Depression is the most important manifestation of non-motor symptoms, which seriously affects the quality of life of patients. Clinicians often use antidepressant drugs to improve the depressive symptoms of patients with Parkinson 's disease, but it is still urgent to solve the problems of drug side effects and drug resistance caused by such methods. Repetitive transcranial magnetic stimulation is a safe and non-invasive neuromodulation technique that can change the excitability of the corticospinal tract, induce the release of dopamine and other neurotransmitters, and further improve the depressive symptoms of patients with Parkinson 's disease. Based on this, this paper discusses and summarizes the research progress on the efficacy and potential mechanism of repetitive transcranial magnetic stimulation for improving depression in Parkinson 's disease at home and abroad, in order to provide reference for related clinical application research.
Objective To observe the clinical effect of repetitive transcranial magnetic stimulation (rTMS) combined with balloon dilatation and routine swallowing training on dysphagia caused by cricopharyngeal dysfunction (CPD) after stroke. Methods Patients with dysphagia after stroke who were hospitalized at Hubei Provincial Hospital of Integrated Chinese and Western Medicine between January 2022 and February 2023 were selected. The patients were divided into the trial group and the control group by random number table method. The control group received balloon dilatation and routine swallowing training, and the trial group received rTMS based on the treatment plan of the control group. All patients were treated for 3 weeks. The videofluoroscopic swallowing study (VFSS), Penetration Aspiration Scale (PAS), and Functional Oral Intake Scale (FOIS) were used at pre-therapy and 3 weeks after treatment to assess the improvement of swallowing function. Results A total of 49 patients were included, including 25 in the trial group and 24 in the control group. There was no statistically significant difference in age, gender, course of disease, stroke type, and swallowing function before treatment between the two groups of patients (P>0.05). After 3 weeks of treatment, the VFSS dysphagia scores (Z=?4.465, ?4.327, P<0.001) of the trial group and the control group were higher than those before treatment, and the trial group was better than that in the control group (t=2.099, P=0.041). The PAS scores (Z=?4.179, ?3.729, P<0.001) and FOIS scores (Z=?4.476, ?4.419, P<0.001) of the trial and control groups were improved after treatment, and the improvement of the PAS score (t=?2.088, P=0.042) and FOIS score (Z=?2.134, P=0.033) in the trial group were more significant (P<0.05). No serious adverse reactions were observed in patients during the study process. Conclusion The rTMS combined with balloon dilatation and routine swallowing training can significantly improve the swallowing function of patients with dysphagia caused by CPD after stroke, and further improve its clinical efficacy, worthy of clinical application.
ObjectiveTo systematically evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on post-stroke depression (PSD).MethodsWe searched databases including the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet, Wanfang, China Biology Medicine database and VIP database to collect randomized controlled trials comparing the effect of the rTMS group and the control group with the scores of depression scale from January 2013 to April 2018. Patients in the rTMS group received rTMS plus drug therapy or conventional treatment for PSD, and patients in the control group received rTMS sham stimulation or not, but the drug treatment or routine treatment was required. When the quality evaluation and data extraction were carried out by two reviewers independently, the Meta-analysis was performed using RevMan 5.3 software and Stata 14.0 software.ResultsA total of 18 literatures involving 1 376 patients (687 patients in the rTMS group and 689 patients in the control group) with PSD were included in this Meta-analysis. Compared with the control group, the rTMS group could effectively reduce the depression scores of PSD patients [standard mean difference (SMD)=–1.13, 95% confidence interval (CI) (–1.42, –0.84), P<0.000 01], and the effective rate of rTMS was 91.7%; meanwhile, rTMS could promote the scores of the National Institute of Health Stroke Scale and the activities of daily living of patients with PSD [SMD=–1.00, 95%CI (–1.25, –0.75), P<0.000 01;SMD=1.56, 95%CI (0.80, 2.32), P<0.000 01]. The source of heterogeneity was not found according to subgroup analysis and Meta-regression analysis. Additionally, few studies reported adverse reactions after the treatment of rTMS.ConclusionsrTMS has a positive effect on depression, neurological deficits, and decreased ability of daily living in patients with PSD. Due to the quality of the included studies, the conclusions need to be verified further.
Transcranial magnetic stimulation (TMS) combined with electroencephalography(EEG) has become an important tool in brain research. However, it is difficult to remove the large artifacts in EEG signals caused by the online TMS intervention. In this paper, we summed up various types of artifacts. After introducing a variety of online methods, the paper emphasized on offline approaches, such as subtraction, principal component analysis and independent component analysis, which can remove or minimize TMS-induced artifacts according to their different characteristics. Although these approaches can deal with most of the artifacts induced by TMS, the removal of large artifacts still needs to be improved. This paper systematically summarizes the effective methods for artifacts removal in TMS-EEG studies. It is a good reference for TMS-EEG researchers while choosing the suitable artifacts removal methods.