重复经颅磁刺激治疗卒中后运动功能障碍有效性和安全性的Meta分析

目的系统评价使用高、低频重复经颅磁刺激（rTMS）治疗卒中后运动功能障碍的有效性和安全性。方法检索Pubmed、EMbase、MEDLINE、Cochrane图书馆、中文期刊全文数据库（CNKI）、中国生物医学文摘数据库（CBMdisc）中,关于rTMS治疗卒中后运动功能障碍的随机对照试验（RCT）。文献检索起止时间均从2001年1月—2011年12月。对符合纳入标准的文献进行Meta分析。结果共纳入10项研究中的496例患者。其中273例采用rTMS治疗,223例为安慰剂形式的rTMS或空白对照。其中8项为有效性研究,2项为安全性研究。①6项行Barthel指数（BI）评估的研究显示,rTMS组的运动功能改善程度优于对照组,差异有统计学意义,治疗前后评分均数差（MD）=-11.17,95%CI：-13.84～-8.50。3项行Fugl-Meyer评分的研究显示,rTMS组的改善程度优于对照组,差异有统计学意义,MD=-7.61,95%CI：-10.79～-4.43。②采用低频rTMS（1 Hz）治疗的4项分析结果表明,rTMS组BI的改善程度优于对照组,差异有统计学意义,MD=-9.28,95%CI：-10.32～-8.24;采用高频rTMS（!1 Hz）治疗的2项研究亦显示,rTMS组的BI改善程度优于对照组,MD=-21.42,95%CI：-29.69～-13.15。③2项进行不良反应的研究显示,rTMS组与对照组间差异无统计学意义,RR=0.75,95%CI：0.24～2.36。2项研究报道的不良事件主要包括头痛、焦虑、疲乏和麻刺感,无癫痫发作。结论对卒中后存在运动功能障碍的患者,采用低频或高频rTMS治疗,均可促进患者运动功能的恢复,并且安全、有效。

Effectiveness and safety of repetitive transcranial magnetic stimulation in patients with post-stroke motor dysfunction:a meta-analysis

Objective To systematically review the effectiveness and safety of high-and low-frequency repetitive transcranial magnetic stimulation(rTMS) in the treatment of post-stroke motor dysfunction.Methods The randomized controlled trials(RCTs) of post-stroke motor dysfunction treated by rTMS were searched on Pubmed,EMbase,MEDLININE,Cochrane library,China National Knowledge Infrastructure(CNKI) and Chinese Biomedical Literature Database on disc(CBMdisc) from January 2001 to December 2011.Meta-analysis was conducted for the literatures met the inclusion criteria.Results A total of 10 RCTs and 496 patients were included,273 patients were treated with rTMS,223 were treated with placebo rTMS or used as blank controls.Eight of the RCTs were effectiveness studies,2 were safety studies.①Six RCTs evaluated with Barthel Index(BI) showed that motor function improvement in the rTMS group was better than that in the control group.The difference was statistically significant.The mean difference(MD) of the score was-11.17(95% CI-13.84 to-8.50) before and after treatment.Three RCTs showed that the improvement of Fugl-Meyer score in the rTMS group was better than that in the control group.The difference was statistically significant(MD=-7.61,95% CI-10.79 to-4.43).②The results of 4 RCTs using the low frequency rTMS(1 Hz) showed that the improvement of BI in the rTMS group was better than that in the control group.The difference was statistically significant(MD=-9.28,95%CI-10.32 to-8.24);2 RCTs using high frequency rTMS(1 Hz) also showed that the improvement of BI in the rTMs group was better than that in the control group(MD=-21.42,95%CI-29.69 to-13.15).③Two RCTs for adverse reactions showed that there was no difference between the rTMs group and the control group(risk ratio =0.75,95%CI 0.24 to 2.36).The main adverse events reported in the 2 RCTs were headache,anxiety,weakness,and tingling.There were no seizures.Conclusion Both low-and high-frequency rTMS may promote the recovery of motor function for patients with post-stroke motor dysfunction,both of them are safe and effective.