Efficacy and Safety of High-Frequency Repetitive Transcranial Magnetic Stimulation for Poststroke Depression: A Systematic Review and Meta-analysis |
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| Affiliation: | 1. Medical School of Shihezi University, Shihezi, Xinjiang, China;2. Department of Psychology Rehabilitation, the First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, Xinjiang, China;1. Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA;2. Department of Occupational Therapy, College of Rehabilitation Science, Thomas Jefferson University, Philadelphia, PA;3. Shriners Hospitals for Children, Philadelphia, PA;4. Shriners Hospitals for Children, Chicago, IL;5. Rush Medical College, Chicago, IL;6. Kennedy Krieger Rehabilitation Institute, Baltimore, MD;7. Shriners Hospitals for Children, Sacramento, CA;8. MGH Institute of Health Professions, Boston, MA;1. TIRR Memorial Hermann, Brain Injury Research Center, Houston, TX;2. Baylor College of Medicine, Department of Physical Medicine and Rehabilitation, Houston, TX;3. Zabolocki VA Medical Center, Milwaukee, WI;4. Craig Hospital, Research Department, Englewood, CO;5. University of Texas Health Science Center at Houston, School of Public Health, Department of Biostatistics and Data Science, Houston, TX;1. Center for Rehabilitation Outcomes Research, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Evanston, Illinois;1. Department of Psychiatry, University of California San Diego, San Diego, CA;2. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI;3. Memory and Aging Center, University of California San Francisco, Department of Neurology, San Francisco, CA;4. Shirley Ryan AbilityLab and Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL |
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| Abstract: | ObjectiveTo summarize and systematically review the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) for depression in patients with stroke.Data SourcesSix databases (Wanfang, the China National Knowledge Infrastructure, PubMed, Embase, Cochrane Library, and Web of Science) were searched from inception until November 15, 2018.Study SelectionSeventeen randomized controlled trials were included for meta-analysis.Data ExtractionTwo independent reviewers selected potentially relevant studies based on the inclusion criteria, extracted data, and evaluated the methodological quality of the eligible trials using the Physiotherapy Evidence Database.Data SynthesisWe calculated the combined effect size (standardized mean difference [SMD] and odds ratio [OR]) for the corresponding effects models. Physiotherapy Evidence Database scores ranged from 7 to 8 points (mean=7.35). The study results indicated that HF-rTMS had significantly positive effects on depression in patients with stroke. The effect sizes of the SMD ranged from small to large (SMD, -1.01; 95% confidence interval [CI], -1.36 to -0.66; P<.001; I2, 85%; n=1053), and the effect sizes of the OR were large (response rates, 58.43% vs 33.59%; OR, 3.31; 95% CI, 2.25-4.88; P<.001; I2, 0%; n=529; remission rates, 26.59% vs 12.60%; OR, 2.72; 95% CI, 1.69-4.38; P<.001; I2, 0%; n=529). In terms of treatment side effects, the HF-rTMS group was more prone to headache than the control group (OR, 3.53; 95% CI, 1.85-8.55; P<.001; I2, 0%; n=496).ConclusionsHF-rTMS is an effective intervention for poststroke depression, although treatment safety should be further verified via large sample multicenter trials. |
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