PDF(Pubmed)
Abstract：
BACKGROUND: The existing literature indicates that repetitive transcranial magnetic stimulation (rTMS) can potentially enhance the prognosis of poststroke aphasia (PSA). Nevertheless, these investigations did not identify the most effective parameters or settings for achieving optimal treatment outcomes. This study involved a meta-analysis aimed to identify the optimal variables for rTMS in treating post-infarction aphasia to guide the use of rTMS in rehabilitating PSA.
METHODS: PubMed, Embase, and Cochrane Library databases were searched from inception to May 2023, and articles were reviewed manually using subject words and free words and supplemented with references from the included literature to obtain additional relevant literature. The search terms included \"poststroke aphasia\" and \"repetitive transcranial magnetic stimulation (rTMS)\" repetitive transcranial magnetic stimulation. Additionally, a review of the reference lists of previously published systematic reviews identified through the Cochrane Database of Systematic Reviews (search terms: poststroke aphasia, rTMS; restrictions: none) and PubMed (search terms: poststroke aphasia, rTMSs; restrictions: systematic review or meta-analysis) was performed. Information from studies involving different doses of rTMS in PSA was independently screened and extracted by 2 researchers.
RESULTS: This meta-analysis included 387 participants with PSA across 18 randomized controlled trials. The results showed that the total pulse had a trend toward a significant correlation with the treatment effect (P = 0.088), while all other variables did not correlate significantly. When rTMS was not grouped by stimulus parameter and location, our nonlinear results showed that when the total pulses were 40,000 (standardized mean difference (SMD):1.86, 95% credible interval (CrI) 0.50 to 3.33), the pulse/session was 1000 (SMD:1.05, 95% CrI 0.55-1.57), and an RMT of 80% (SMD:1.08, 95% CrI 0.60-1.57) had the best treatment effect. When rTMS was grouped by stimulus parameters and location, our nonlinear results showed that when the total low-frequency (LF)-rTMS-right inferior frontal gyrus (RIFG) pulse was 40,000 (SMD:1.76, 95% CrI:0.36-3.29), the pulse/session was 1000 (SMD:1.06, 95% CrI:0.54-1.59). Optimal results were obtained with an RMT of 80% (SMD:1.14, 95% CrI 0.54 - 1.76).
CONCLUSIONS: The optimal treatment effects of rTMS for PSA may be obtained with a total pulse of 40,000, a pulse/session of 1000, and an RMT of 80%. Further rigorous randomized controlled studies are required to substantiate the validity of these results.
METHODS: PubMed, Embase, and Cochrane Library databases were searched from inception to May 2023, and articles were reviewed manually using subject words and free words and supplemented with references from the included literature to obtain additional relevant literature. The search terms included \"poststroke aphasia\" and \"repetitive transcranial magnetic stimulation (rTMS)\" repetitive transcranial magnetic stimulation. Additionally, a review of the reference lists of previously published systematic reviews identified through the Cochrane Database of Systematic Reviews (search terms: poststroke aphasia, rTMS; restrictions: none) and PubMed (search terms: poststroke aphasia, rTMSs; restrictions: systematic review or meta-analysis) was performed. Information from studies involving different doses of rTMS in PSA was independently screened and extracted by 2 researchers.
RESULTS: This meta-analysis included 387 participants with PSA across 18 randomized controlled trials. The results showed that the total pulse had a trend toward a significant correlation with the treatment effect (P = 0.088), while all other variables did not correlate significantly. When rTMS was not grouped by stimulus parameter and location, our nonlinear results showed that when the total pulses were 40,000 (standardized mean difference (SMD):1.86, 95% credible interval (CrI) 0.50 to 3.33), the pulse/session was 1000 (SMD:1.05, 95% CrI 0.55-1.57), and an RMT of 80% (SMD:1.08, 95% CrI 0.60-1.57) had the best treatment effect. When rTMS was grouped by stimulus parameters and location, our nonlinear results showed that when the total low-frequency (LF)-rTMS-right inferior frontal gyrus (RIFG) pulse was 40,000 (SMD:1.76, 95% CrI:0.36-3.29), the pulse/session was 1000 (SMD:1.06, 95% CrI:0.54-1.59). Optimal results were obtained with an RMT of 80% (SMD:1.14, 95% CrI 0.54 - 1.76).
CONCLUSIONS: The optimal treatment effects of rTMS for PSA may be obtained with a total pulse of 40,000, a pulse/session of 1000, and an RMT of 80%. Further rigorous randomized controlled studies are required to substantiate the validity of these results.
摘要：
背景：现有文献表明，重复经颅磁刺激（rTMS）可能会增强卒中后失语症（PSA）的预后。然而，这些研究没有确定实现最佳治疗结局的最有效参数或设置.这项研究涉及一项荟萃分析，旨在确定rTMS治疗梗死后失语症的最佳变量，以指导rTMS在PSA康复中的使用。
方法：PubMed，Embase,和Cochrane图书馆数据库从开始到2023年5月进行了检索,文章使用主题词和自由词进行了手动审查,并补充了纳入文献的参考文献,以获得更多相关文献.搜索词包括“中风后失语症”和“重复经颅磁刺激（rTMS）”重复经颅磁刺激。此外,对通过Cochrane系统评价数据库确定的先前发表的系统评价的参考列表的回顾(搜索词：卒中后失语症，rTMS；限制：无)和PubMed(搜索词：中风后失语症，rTMS；限制：系统评价或荟萃分析）。来自PSA中涉及不同剂量rTMS的研究的信息由2名研究人员独立筛选和提取。
结果：这项荟萃分析包括18项随机对照试验中的387名PSA患者。结果表明，总脉搏与治疗效果呈显著相关(P=0.088)。而所有其他变量没有显着相关。当rTMS未按刺激参数和位置分组时，我们的非线性结果表明，当总脉冲为40,000时（标准化平均差（SMD）：1.86，95％可信间隔（CrI）0.50至3.33），脉冲/会话为1000（SMD：1.05，95％CrI0.55-1.57），80％的RMT（SMD：1.08，95％CrI0.60-1.57）具有最佳的治疗效果。当rTMS按刺激参数和位置分组时，我们的非线性结果表明，当总低频（LF）-rTMS-右额下回（RIFG）脉冲为40,000（SMD：1.76，95％CrI：0.36-3.29）时，脉冲/疗程为1000（SMD：1.06，95％CrI：0.54-1.59）。用80%的RMT(SMD:1.14,95%CrI0.54-1.76)获得最佳结果。
结论：rTMS对PSA的最佳治疗效果可能是总脉冲为40,000，脉冲/疗程为1000，RMT为80％。需要进一步严格的随机对照研究来证实这些结果的有效性。
方法：PubMed，Embase,和Cochrane图书馆数据库从开始到2023年5月进行了检索,文章使用主题词和自由词进行了手动审查,并补充了纳入文献的参考文献,以获得更多相关文献.搜索词包括“中风后失语症”和“重复经颅磁刺激（rTMS）”重复经颅磁刺激。此外,对通过Cochrane系统评价数据库确定的先前发表的系统评价的参考列表的回顾(搜索词：卒中后失语症，rTMS；限制：无)和PubMed(搜索词：中风后失语症，rTMS；限制：系统评价或荟萃分析）。来自PSA中涉及不同剂量rTMS的研究的信息由2名研究人员独立筛选和提取。
结果：这项荟萃分析包括18项随机对照试验中的387名PSA患者。结果表明，总脉搏与治疗效果呈显著相关(P=0.088)。而所有其他变量没有显着相关。当rTMS未按刺激参数和位置分组时，我们的非线性结果表明，当总脉冲为40,000时（标准化平均差（SMD）：1.86，95％可信间隔（CrI）0.50至3.33），脉冲/会话为1000（SMD：1.05，95％CrI0.55-1.57），80％的RMT（SMD：1.08，95％CrI0.60-1.57）具有最佳的治疗效果。当rTMS按刺激参数和位置分组时，我们的非线性结果表明，当总低频（LF）-rTMS-右额下回（RIFG）脉冲为40,000（SMD：1.76，95％CrI：0.36-3.29）时，脉冲/疗程为1000（SMD：1.06，95％CrI：0.54-1.59）。用80%的RMT(SMD:1.14,95%CrI0.54-1.76)获得最佳结果。
结论：rTMS对PSA的最佳治疗效果可能是总脉冲为40,000，脉冲/疗程为1000，RMT为80％。需要进一步严格的随机对照研究来证实这些结果的有效性。
