不同重复经颅磁刺激模式对脑卒中后上肢运动功能障碍干预效果的网状Meta分析

Background Upper limb motor dysfunction is one of the common complications after strokeand seriously affects the daily living of patients. As a common neurophysiological technique, repetitive transcranial magnetic stimulation (rTMS) has a good effect on the treatment of upper limb motor dysfunction after stroke. Howeverthe selection of different rTMS modes has not been identified by evidence-based studies in clinical practice. Objective To evaluate the clinical efficacy of four modalities of rTMS in stroke patients with upper limb motor dysfunction by network meta-analysis. Methods Randomized controlled trials about rTMS for treating upper limb motor dysfunction after stroke were searched in databases of PubMedEMbaseThe Cochrane LibraryWeb of ScienceCBMCNKIWanfang Databaseand VIP from inception to February 2022. RevMan 5.0 software and Stata 14.0 software were used to analyze the data involved.Results Finallya total of 17 studies were included and 790 stroke patients were eligible for this study. Network Meta-analysis results showed that compared with sham stimulation and conventional therapyfour intervention modes of rTMS can significantly increase the FMA-UEMBI and BI scoresand significantly decrease the MAS and MEP latency scores in patients with upper limb motor dysfunction after stroke. The surface under the cumulative ranking indicated that LF-rTMS had advantages in increasing FMA-UEMBI and BI scores. iTBS may be the best therapy in decreasing the score of MAS scale. HF-rTMS may be better than LF-rTMSiTBS and cTBS in reducing MEP latency. Conclusion The available evidence indicates that LF-rTMS is significantly more effective than HF-rTMSiTBSand cTBS in improving upper limb motor function and activities of daily living compared with sham stimulation and conventional therapy. iTBS has more obvious advantages in decreasing upper limb muscle tension. HF-rTMS is the best option for improving corticospinal excitability.