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Journal of Affective Disorders Apr 2022Background We evaluated the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for obsessive-compulsive disorder (OCD), and ranked the relative... (Meta-Analysis)
Meta-Analysis Review
Background We evaluated the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for obsessive-compulsive disorder (OCD), and ranked the relative efficacy of different stimulation protocols. Methods We performed a search for randomised, sham-controlled trials of rTMS for OCD. The primary analysis included both a pairwise meta-analysis and a series of frequentist network meta-analyses (NMA) of OCD symptom severity. Secondary analyses were carried out on relevant clinical factors and safety. Results 21 studies involving 662 patients were included. The pairwise meta-analysis showed that rTMS for OCD is efficacious across all protocols (Hedges' g=-0.502 [95%CI= -0.708, -0.296]). The first NMA, with stimulation protocols clustered only by anatomical location, showed that both dorsolateral prefrontal cortex (dlPFC) stimulation and medial frontal cortex stimulation were efficacious. In the second NMA, considering each unique combination of frequency and location separately, low frequency (LF) pre-supplementary motor area (preSMA) stimulation, high frequency (HF) bilateral dlPFC stimulation, and LF right dlPFC stimulation were all efficacious . LF right dlPFC was ranked highest in terms of efficacy, although the corresponding confidence intervals overlapped with the other two protocols. Limitations Evidence base included mostly small studies, with only a few studies using similar protocols, giving a sparse network. Studies were heterogeneous, and a risk of publication bias was found. Conclusions rTMS for OCD was efficacious compared with sham stimulation. LF right dlPFC, HF bilateral dlPFC and LF preSMA stimulation were all efficacious protocols with significant and comparable clinical improvements. Future studies should further investigate the relative merits of these three protocols.
Topics: Humans; Motor Cortex; Network Meta-Analysis; Obsessive-Compulsive Disorder; Prefrontal Cortex; Transcranial Magnetic Stimulation; Treatment Outcome
PubMed: 35041869
DOI: 10.1016/j.jad.2022.01.048 -
Neurology Jun 2008To conduct a systematic review and meta-analysis to quantify the efficacy of invasive and noninvasive brain stimulation for the treatment of chronic pain. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To conduct a systematic review and meta-analysis to quantify the efficacy of invasive and noninvasive brain stimulation for the treatment of chronic pain.
METHODS
MEDLINE and other databases were searched as data sources. Reference lists and conference abstracts were examined for further relevant articles. We included studies that evaluated the effects of invasive and noninvasive brain stimulation of motor cortex on chronic pain using the visual analogue scale. Eleven studies using noninvasive brain stimulation and 22 studies using invasive brain stimulation met our inclusion criteria. The results showed that weighted responder rate was 72.6% (95% CI, 67.7-77.4) for the invasive stimulation studies and 45.3% (95% CI, 39.2-51.4) for the noninvasive stimulation studies. This difference was significant. For the noninvasive stimulation studies, the random effects model revealed that the number of responders in the active group was significantly higher as compared with sham stimulation group (risk ratio of 2.64) (95% CI, 1.63-4.30).
CONCLUSIONS
This meta-analysis shows that two different techniques of brain stimulation of motor cortex--invasive and noninvasive--can exert a significant effect on pain in patients with chronic pain. We discuss potential reasons that invasive brain stimulation showed a larger effect in this meta-analysis. Our findings encourage continuation of research in this area and highlight the need for well-designed clinical trials to define the role of brain stimulation in pain management.
Topics: Electric Stimulation Therapy; Female; Humans; MEDLINE; Middle Aged; Motor Cortex; Pain Management; Pain Measurement; Review Literature as Topic; Treatment Outcome
PubMed: 18541887
DOI: 10.1212/01.wnl.0000314649.38527.93 -
Research in Developmental Disabilities Sep 2016The core characteristic of attention deficit hyperactivity disorder (ADHD) is a persistent pattern of inattention and/or hyperactivity-impulsivity that causes... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The core characteristic of attention deficit hyperactivity disorder (ADHD) is a persistent pattern of inattention and/or hyperactivity-impulsivity that causes developmental or functional impairment. Observational studies have investigated neurophysiological features in individuals with ADHD using transcranial magnetic stimulation (TMS) to identify which intracortical mechanisms are associated with the symptoms. This systematic review aimed to assess the quality of these studies and present meta-analyses of the available neurophysiological measures.
METHODS
This systematic review searched the PubMed, Scopus, Web of Science, with no date restrictions. The methodological quality of observational studies was assessed utilizing the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The analysis of the mean and standard deviation of the neurophysiological measurements was performed using the RevMan software version 5.0 for the meta-analyses of studies.
RESULTS
Nine publications that met the inclusion criteria were evaluated. Most of the AHRQ criteria were satisfied, indicating the good quality of the studies. On comparing subjects with ADHD and controls, the forest plot profiles were similar in respect to the resting motor threshold (RMT), and silent period (SP) but a significant difference was found for short intracortical inhibition (SICI).
CONCLUSION
This meta-analysis found reduced SICI in individuals with ADHD, when compared with controls. Given the small number of studies, it is important that further studies be conducted for a more robust conclusion to be formed.
Topics: Attention Deficit Disorder with Hyperactivity; Case-Control Studies; Evoked Potentials, Motor; Humans; Motor Cortex; Neural Inhibition; Transcranial Magnetic Stimulation
PubMed: 27240241
DOI: 10.1016/j.ridd.2016.01.022 -
Journal of Bodywork and Movement... Jul 2016Chronic low back pain (CLBP) is a prevalent issue that engenders enormous social and economic burdens. Recently, kinesio taping (KT) has become of interest in the... (Review)
Review
BACKGROUND
Chronic low back pain (CLBP) is a prevalent issue that engenders enormous social and economic burdens. Recently, kinesio taping (KT) has become of interest in the management of chronic pain. Accordingly, this is the first systematic review to explicitly report the effects of KT on CLBP.
OBJECTIVE
The aim of this review was to summarize the results of randomized controlled trials (RCTs) investigating the effects of KT on CLBP.
METHODS
A search was performed on the electronic databases PubMed, MEDLINE, SPORT Discus and Science Direct, up to June 17, 2015, using the following keywords: Kinesiology taping, kinesio taping, chronic low back pain.
RESULTS
In total, five studies involving 306 subjects met the inclusion criteria and corresponded to the aim of this review. The methodological quality of the included RCTs was good, with a mean score of 6.6 on the 10-point PEDro Scale. Moderate evidence suggests KT, as a sole treatment or in conjunction with another treatment, is no more effective than conventional physical therapy and exercise with respect to improving pain and disability outcomes. There is insufficient evidence suggesting that KT is superior to sham taping in improving pain and disability. Limited evidence suggests that KT is more effective than sham taping in improving range of motion (ROM) and global perceived effect (GPE) in the short term. Very limited evidence indicates that KT is more effective than conventional physical therapy in improving anticipatory postural control of the transversus abdominus muscles and improved cerebral cortex potential.
CONCLUSION
Kinesio taping is not a substitute for traditional physical therapy or exercise. Rather, KT may be most effective when used as an adjunctive therapy, perhaps by improving ROM, muscular endurance and motor control. More high quality studies that consider the multiple factors that mediate CLBP, in the short, intermediate and long term, are needed to strengthen the evidence of the effectiveness of KT on CLBP.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42015023837.
Topics: Athletic Tape; Disability Evaluation; Fear; Humans; Low Back Pain; Pain Measurement; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Range of Motion, Articular
PubMed: 27634093
DOI: 10.1016/j.jbmt.2016.04.018 -
The Journal of Pain Nov 2013Dysfunction in the central nervous system is thought to underlie the movement disorders that commonly occur in complex regional pain syndrome (CRPS), with much of the... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Dysfunction in the central nervous system is thought to underlie the movement disorders that commonly occur in complex regional pain syndrome (CRPS), with much of the literature focusing on reorganization of the primary motor cortex (M1). Presumed changes in the M1 representation of the CRPS-affected body part have contributed to new CRPS treatments, which are increasingly being integrated in the clinic. We systematically investigated the evidence for altered M1 function in CRPS. We adhered to rigorous systematic review procedure in our search strategy, risk-of-bias appraisal, and data extraction. Eighteen studies comprising 14 unique data sets were included. The included studies used several neuroimaging techniques, whose outcomes we grouped into M1 cortical excitability, spatial representation, reactivity, and glucose metabolism, and conducted meta-analyses where possible. Risk of bias across studies was high, mainly due to missing data and unblinded assessment of outcomes. No definitive conclusions can be drawn regarding M1 spatial representation, reactivity, or glucose metabolism in CRPS. There is limited evidence for bilateral M1 disinhibition in CRPS of the upper limb.
PERSPECTIVE
Despite widely held assumptions of primary motor cortex dysfunction in complex regional pain syndrome, there is only evidence to support bilateral disinhibition, and there is high risk of bias across the literature.
Topics: Complex Regional Pain Syndromes; Humans; Motor Cortex; Pain; Pain Measurement
PubMed: 24035350
DOI: 10.1016/j.jpain.2013.07.004 -
Frontiers in Aging Neuroscience 2022Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease whose primary hallmark is the progressive degeneration of motor neurons in the brainstem,...
Mixed Comparison of Different Exercise Interventions for Function, Respiratory, Fatigue, and Quality of Life in Adults With Amyotrophic Lateral Sclerosis: Systematic Review and Network Meta-Analysis.
BACKGROUND
Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease whose primary hallmark is the progressive degeneration of motor neurons in the brainstem, spinal cord, and cerebral cortex that leads to weakness, spasticity, fatigue, skeletal muscle atrophy, paralysis, and even death. Exercise, as a non-pharmacological tool, may generally improve muscle strength, cardiovascular function, and quality of life. However, there are conflicting reports about the effect of exercise training in adults with ALS.
AIMS
This systematic review and network meta-analysis aim to conduct a mixed comparison of different exercise interventions for function, respiratory, fatigue, and quality of life in adults with ALS.
METHODS
Randomized controlled trials with ALS participants were screened and included from the databases of PubMed, Medline, and Web of Science. Physical exercise interventions were reclassified into aerobic exercise, resistance training, passive exercise, expiratory muscle exercise, and standard rehabilitation. Patient-reported outcome measures would be reclassified from perspectives of function, respiratory, fatigue, and quality of life. The effect size would be transferred into the percentage change of the total score.
RESULT
There were 10 studies included, with the agreement between authors reaching a kappa-value of 0.73. The network meta-analysis, which was conducted under the consistency model, identified that a combined program of aerobic exercise, resistance exercise, and standard rehabilitation showed the highest potential to improve quality of life (0.64 to be the best) and reduce the fatigue (0.39 to be the best) for ALS patients, while exercise program of aerobic and resistance training showed the highest potential (0.51 to be the best) to improve ALS patients' physical function. The effect of exercise on the respiratory was still unclear.
CONCLUSION
A multi-modal exercise and rehabilitation program would be more beneficial to ALS patients. However, the safety and guide for practice remain unclear, and further high-quality randomized controlled trials (RCTs) with a larger sample are still needed.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021253442, CRD42021253442.
PubMed: 35898325
DOI: 10.3389/fnagi.2022.919059 -
The Journal of Pain Apr 2018Chronic pain can be associated with movement abnormalities. The primary motor cortex (M1) has an essential role in the formulation and execution of movement. A number of... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Chronic pain can be associated with movement abnormalities. The primary motor cortex (M1) has an essential role in the formulation and execution of movement. A number of changes in M1 function have been reported in studies of people with chronic pain. This review systematically evaluated the evidence for altered M1 structure, organization, and function in people with chronic pain of neuropathic and non-neuropathic origin. Database searches were conducted and a modified STrengthening the Reporting of OBservational studies in Epidemiology checklist was used to assess the methodological quality of included studies. Meta-analyses, including preplanned subgroup analyses on the basis of condition were performed where possible. Sixty-seven studies (2,290 participants) using various neurophysiological measures were included. There is conflicting evidence of altered M1 structure, organization, and function for neuropathic and non-neuropathic pain conditions. Meta-analyses provided evidence of increased M1 long-interval intracortical inhibition in chronic pain populations. For most measures, the evidence of M1 changes in chronic pain populations is inconclusive.
PERSPECTIVE
This review synthesizes the evidence of altered M1 structure, organization, and function in chronic pain populations. For most measures, M1 changes are inconsistent between studies and more research with larger samples and rigorous methodology is required to elucidate M1 changes in chronic pain populations.
Topics: Chronic Pain; Databases, Bibliographic; Humans; Magnetic Resonance Imaging; Motor Cortex; Movement Disorders
PubMed: 29155209
DOI: 10.1016/j.jpain.2017.10.007 -
EClinicalMedicine Oct 2022Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive form of brain stimulation that positively regulates the motor and non-motor symptoms of Parkinson's...
BACKGROUND
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive form of brain stimulation that positively regulates the motor and non-motor symptoms of Parkinson's disease (PD). Although, most reviews and meta-analysis have shown that rTMS intervention is effective in treating motor symptoms and depression, very few have used randomised controlled trials (RCTs) to analyse the efficacy of this intervention in PD. We aimed to review RCTs of rTMS in patients with PD to assess the efficacy of rTMS on motor and non-motor function in patients with PD.
METHODS
In this systematic review and meta-analysis, we searched PubMed, MEDLINE and Web of Science databases for RCTs on rTMS in PD published between January 1, 1988 to January 1, 2022. Eligible studies included sham-controlled RCTs that used rTMS stimulation for motor or non-motor symptoms in PD. RCTs not focusing on the efficacy of rTMS in PD were excluded. Summary data were extracting from those RCTs by two investigators independently. We then calculated standardised mean difference with random-effect models. The main outcome included motor and non-motor examination of scales that were used in PD motor or non-motor assessment. This study was registered with PROSPERO, CRD42022329633.
FINDINGS
Fourteen studies with 469 patients met the criteria for our meta-analysis. Twelve eligible studies with 381 patients were pooled to analyse the efficacy of rTMS on motor function improvement. The effect size on motor scale scores was 0.51 ( < 0.0001) and were not distinctly heterogeneous (I = 29%). Five eligible studies with 202 patients were collected to evaluate antidepressant-like effects. The effect size on depression scale scores was 0.42 ( = 0.004), and were not distinctly heterogeneous (I = 25%), indicating a significant anti-depressive effect (P = 0.004). The results suggest that high-frequency of rTMS on primary motor cortex (M1) is effective in improving motor symptoms; while the dorsolateral prefrontal cortex (DLPFC) may be a potentially effective area in alleviating depressive symptom.
INTERPRETATION
The findings suggest that rTMS could be used as a possible adjuvant therapy for PD mainly to improve motor symptoms, but could have potential efficacy on depressive symptoms of PD. However, further investigation is needed.
FUNDING
The National Natural Science Foundation of China (NO: 81873777, 82071414), Initiated Foundation of Zhujiang Hospital (NO: 02020318005), Scientific Research Foundation of Guangzhou (NO: 202206010005), and Science and Technology Program of Guangdong of China (NO: 2020A0505100037).
PubMed: 35923424
DOI: 10.1016/j.eclinm.2022.101589 -
Frontiers in Human Neuroscience 2015Motor cortex excitability can be measured by single- and paired-pulse transcranial magnetic stimulation (TMS). Repetitive transcranial magnetic stimulation (rTMS) can... (Review)
Review
Motor cortex excitability can be measured by single- and paired-pulse transcranial magnetic stimulation (TMS). Repetitive transcranial magnetic stimulation (rTMS) can induce neuroplastic effects in stimulated and in functionally connected cortical regions. Due to its ability to non-invasively modulate cortical activity, rTMS has been investigated for the treatment of various neurological and psychiatric disorders. However, such studies revealed a high variability of both clinical and neuronal effects induced by rTMS. In order to better elucidate this meta-plasticity, rTMS-induced changes in motor cortex excitability have been monitored in various studies in a pre-post stimulation design. Here, we give a literature review of studies investigating motor cortex excitability changes as a neuronal marker for rTMS effects over non-motor cortical areas. A systematic literature review in April 2014 resulted in 29 articles in which motor cortex excitability was assessed before and after rTMS over non-motor areas. The majority of the studies focused on the stimulation of one of three separate cortical areas: the prefrontal area (17 studies), the cerebellum (8 studies), or the temporal cortex (3 studies). One study assessed the effects of multi-site rTMS. Most studies investigated healthy controls but some also stimulated patients with neuropsychiatric conditions (e.g., affective disorders, tinnitus). Methods and findings of the identified studies were highly variable showing no clear systematic pattern of interaction of non-motor rTMS with measures of motor cortex excitability. Based on the available literature, the measurement of motor cortex excitability changes before and after non-motor rTMS has only limited value in the investigation of rTMS related meta-plasticity as a neuronal state or as a trait marker for neuropsychiatric diseases. Our results do not suggest that there are systematic alterations of cortical excitability changes during rTMS treatment, which calls into question the practice of re-adjusting the stimulation intensity according to the motor threshold over the course of the treatment.
PubMed: 26257632
DOI: 10.3389/fnhum.2015.00416 -
Journal of Neuroengineering and... Feb 2022Transcranial magnetic stimulation (TMS) has attracted plenty of attention as it has been proved to be effective in facilitating motor recovery in patients with stroke.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Transcranial magnetic stimulation (TMS) has attracted plenty of attention as it has been proved to be effective in facilitating motor recovery in patients with stroke. The aim of this study was to systematically review the effects of repetitive TMS (rTMS) and theta burst stimulation (TBS) protocols in modulating cortical excitability after stroke.
METHODS
A literature search was carried out using PubMed, Medline, EMBASE, CINAHL, and PEDro, to identify studies that investigated the effects of four rTMS protocols-low and high frequency rTMS, intermittent and continuous TBS, on TMS measures of cortical excitability in stroke. A random-effects model was used for all meta-analyses.
RESULTS
Sixty-one studies were included in the current review. Low frequency rTMS was effective in decreasing individuals' resting motor threshold and increasing the motor-evoked potential of the non-stimulated M1 (affected M1), while opposite effects occurred in the stimulated M1 (unaffected M1). High frequency rTMS enhanced the cortical excitability of the affected M1 alone. Intermittent TBS also showed superior effects in rebalancing bilateral excitability through increasing and decreasing excitability within the affected and unaffected M1, respectively. Due to the limited number of studies found, the effects of continuous TBS remained inconclusive. Motor impairment was significantly correlated with various forms of TMS measures.
CONCLUSIONS
Except for continuous TBS, it is evident that these protocols are effective in modulating cortical excitability in stroke. Current evidence does support the effects of inhibitory stimulation in enhancing the cortical excitability of the affected M1.
Topics: Cortical Excitability; Evoked Potentials, Motor; Humans; Motor Cortex; Stroke; Transcranial Magnetic Stimulation
PubMed: 35193624
DOI: 10.1186/s12984-022-00999-4