The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials

Frontiers in Neuroscience

Neuroscience

Yujie Chen¹  Yue Lan¹  Wenqing Yang¹  Jixiang Chen¹  Xiaotong Li¹  Shunxi Zhang¹  Lingling Tian²  Lanfang Xie²  Hai Li²  Bingshui Wang²  Wenxue Ji²  Xijun Wei²  Songbin Chen³  Yangkang Zeng⁴  Huangjie Huang⁵ 

[1] Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China;Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China;Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China;Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China;Department of Rehabilitation Medicine, Shenzhen University General Hospital, Shenzhen, China;Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China;

关键词: stroke;    intermittent theta burst stimulation;    upper limb function;    meta-analysis;    rehabilitation;   

DOI  :  10.3389/fnins.2023.1272003

 received in 2023-08-03, accepted in 2023-09-21,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundIntermittent theta burst stimulation (iTBS) is a promising noninvasive therapy to restore the excitability of the cortex, and subsequently improve the function of the upper extremities. Several studies have demonstrated the effectiveness of iTBS in restoring upper limb function and modulating cortical excitability. We aimed to evaluate the effects of iTBS on upper limb motor recovery after stroke.ObjectiveThe purpose of this article is to evaluate the influence of intermittent theta-burst stimulation on upper limb motor recovery and improve the quality of life.MethodA literature search was conducted using PubMed, EMBASE, MEDLINE, The Cochrane Library, Web of Science, and CBM, including only English studies, to identify studies that investigated the effects of iTBS on upper limb recovery, compared with sham iTBS used in control groups. Effect size was reported as standardized mean difference (SMD) or weighted mean difference (WMD).ResultsTen studies were included in the meta-analysis. The results of the meta-analysis indicated that when compared to the control group, the iTBS group had a significant difference in the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) (WMD: 3.20, 95% CI: 1.42 to 4.97; WMD: 3.72, 95% CI: 2.13 to 5.30, respectively). In addition, there was also a significant improvement in the modified Ashworth scale (MAS) compared to the sham group (WMD: −0.56; 95% CI: −0.85 to −0.28). More evidence is still needed to confirm the effect of Barthel Index (BI) scores after interventions. However, no significant effect was found for the assessment of Motor Evoked Potential (MEP) amplitude and MEP latency (SMD: 0.35; 95% CI: −0.21 to 0.90; SMD: 0.35, 95% CI: −0.18 to 0.87; SMD: 0.03, 95% CI: −0.49 to 0.55; respectively).ConclusionOur results showed that iTBS significantly improved motor impairment, functional activities, and reduced muscle tone of upper limbs, thereby increasing the ability to perform Activities of Daily Living (ADL) in stroke patients, while there were no significant differences in MEPs. In conclusion, iTBS is a promising non-invasive brain stimulation as an adjunct to therapy and enhances the therapeutic effect of conventional physical therapy. In the future, more randomized controlled trials with large sample sizes, high quality, and follow-up are necessary to explore the neurophysiological effects.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023392739.

【 授权许可】

Unknown   
Copyright © 2023 Chen, Zhang, Yang, Chen, Wang, Chen, Li, Xie, Huang, Zeng, Tian, Ji, Wei, Lan and Li.