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Frontiers in Human Neuroscience 2023Disorders of consciousness (DoC) commonly occurs secondary to severe neurological injury. A considerable volume of research has explored the effectiveness of different...
BACKGROUND
Disorders of consciousness (DoC) commonly occurs secondary to severe neurological injury. A considerable volume of research has explored the effectiveness of different non-invasive neuromodulation therapy (NINT) on awaking therapy, however, equivocal findings were reported.
OBJECTIVE
The aim of this study was to systematically investigate the effectiveness on level of consciousness of different NINT in patients with DoC and explore optimal stimulation parameters and characteristics of patients.
METHODS
PubMed, Embase, Web of Science, Scopus, and Cochrane central register of controlled trials were searched from their inception through November 2022. Randomized controlled trials, that investigated effectiveness on level of consciousness of NINT, were included. Mean difference (MD) with 95% confidence interval (CI) was evaluated as effect size. Risk of bias was assessed with revised Cochrane risk-of-bias tool.
RESULTS
A total of 15 randomized controlled trials with 345 patients were included. Meta-analysis was performed on 13 out of 15 reviewed trials indicating that transcranial Direct Current Stimulation (tDCS), Transcranial Magnetic Stimulation (TMS), and median nerve stimulation (MNS) all had a small but significant effect (MD 0.71 [95% CI 0.28, 1.13]; MD 1.51 [95% CI 0.87, 2.15]; MD 3.20 [95%CI: 1.45, 4.96]) on level of consciousness. Subgroup analyses revealed that patients with traumatic brain injury, higher initial level of consciousness (minimally conscious state), and shorter duration of prolonged DoC (subacute phase of DoC) reserved better awaking ability after tDCS. TMS also showed encouraging awaking effect when stimulation was applied on dorsolateral prefrontal cortex in patients with prolonged DoC.
CONCLUSION
tDCS and TMS appear to be effective interventions for improving level of consciousness of patients with prolonged DoC. Subgroup analyses identified the key parameters required to enhance the effects of tDCS and TMS on level of consciousness. Etiology of DoC, initial level of consciousness, and phase of DoC could act as significant characteristics of patients related to the effectiveness of tDCS. Stimulation site could act as significant stimulation parameter related to the effectiveness of TMS. There is insufficient evidence to support the use of MNS in clinical practice to improve level of consciousness in patients with coma.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=337780, identifier: CRD42022337780.
PubMed: 37292582
DOI: 10.3389/fnhum.2023.1129254 -
Frontiers in Neuroscience 2023Post-stroke cognitive impairment (PSCI) is a significant health concern. Transcranial magnetic stimulation (TMS) is considered a promising rehabilitation therapy for...
Effects of excitatory transcranial magnetic stimulation over the different cerebral hemispheres dorsolateral prefrontal cortex for post-stroke cognitive impairment: a systematic review and meta-analysis.
BACKGROUND
Post-stroke cognitive impairment (PSCI) is a significant health concern. Transcranial magnetic stimulation (TMS) is considered a promising rehabilitation therapy for improving cognition, and the effects of excitatory TMS on PSCI have received much attention in recent years. However, the effects of different cerebral hemispheres on excitatory TMS treatment of cognitive impairment have not been studied. This review aimed to study the effects of excitatory TMS over the dorsolateral prefrontal cortex (DLPFC) of different cerebral hemispheres on the cognitive function of patients with PSCI.
METHODS
Literature published in PubMed, Web of Science, Embase, Cochrane Library, Scopus, and Wiley from inception to September 30, 2022, were searched. Two researchers independently performed literature screening, data extraction, and quality assessment. Furthermore, we conducted a meta-analysis using RevMan software (version 5.4) and rated the strength of evidence using GRADEpro.
RESULTS
A total of 19 studies were included in this meta-analysis. The results showed that excitatory TMS over the left hemisphere DLPFC was significantly better in improving global cognition (SMD = 2.26, 95% CI 1.67-2.86, < 0.00001; vs. SMD = 2.53, 95% CI 1.86-3.20, < 0.00001), memory (SMD = 1.29, 95% CI 0.72-1.87, < 0.0001), attention (SMD = 2.32, 95% CI 1.64-3.01, < 0.00001), executive (SMD = 0.64, 95% CI 0.21-1.07, = 0.004), P300 latency (SMD = 2.69, 95% CI 2.13-3.25, < 0.00001), and depression (SMD = 0.95, 95% CI 0.26-1.63, = 0.007) than that of the control group, but the effect on improving activities of daily living (ADL) was unclear ( = 0.03 vs. = 0.17). Subgroup analysis further showed that excitatory TMS over the right hemisphere DLPFC was effective in improving the global cognition of PSCI patients ( < 0.00001), but the stimulation effect over the ipsilateral hemisphere DLPFC was unclear ( = 0.11 vs. = 0.003). Additionally, excitatory TMS over the ipsilateral hemisphere DLPFC showed no statistical difference in improving ADL between the two groups ( = 0.25).
CONCLUSIONS
Compared to other hemispheric sides, excitatory TMS over the left hemisphere DLPFC was a more effective stimulation area, which can significantly improved the global cognitive function, memory, attention, executive, P300 latency, and depression in patients with PSCI. There was no apparent therapeutic effect on improving activities of daily living (ADL). In the future, more randomized controlled trials with large-sample, high quality, and follow-up are necessary to explore a usable protocol further.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022369096.
PubMed: 37260845
DOI: 10.3389/fnins.2023.1102311 -
Frontiers in Human Neuroscience 2023In recent years, repetitive transcranial magnetic stimulation (rTMS) has emerged as a noninvasive and painless treatment for post-stroke cognitive impairment (PSCI)....
BACKGROUND
In recent years, repetitive transcranial magnetic stimulation (rTMS) has emerged as a noninvasive and painless treatment for post-stroke cognitive impairment (PSCI). However, few studies have analyzed the intervention parameters of cognitive function and the effectiveness and safety of rTMS for treating patients with PSCI. Thus, this meta-analysis aimed to analyze the interventional parameters of rTMS and evaluate the safety and effectiveness of rTMS for treating patients with PSCI.
METHODS
According to the PRISMA guidelines, we searched the Web of Science, PubMed, EBSCO, Cochrane Library, PEDro, and Embase to retrieve randomized controlled trials (RCTs) of rTMS for the treatment of patients with PSCI. Studies were screened according to the inclusion and exclusion criteria, and two reviewers independently performed literature screening, data extraction, and quality assessment. RevMan 5.40 software was used for data analysis.
RESULTS
12 RCTs involving 497 patients with PSCI met the inclusion criteria. In our analysis, rTMS had a positive therapeutic effect on cognitive rehabilitation in patients with PSCI ( < 0.05). Both high-frequency rTMS and low-frequency rTMS were effective in improving the cognitive function of patients with PSCI by stimulating the dorsolateral prefrontal cortex (DLPFC), but their efficacy was not statistically different ( > 0.05).
CONCLUSIONS
rTMS treatment on the DLPFC can improve cognitive function in patients with PSCI. There is no significant difference in the treatment effect of high-frequency rTMS and low-frequency rTMS in patients with PSCI between high-frequency and low-frequency rTMS.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323720, identifier CRD 42022323720.
PubMed: 37250691
DOI: 10.3389/fnhum.2023.1177594 -
Journal of Clinical Medicine May 2023Gambling disorder (GD) and internet gaming disorder (IGD) are formally recognized behavioral addictions with a rapidly growing prevalence and limited treatment options.... (Review)
Review
Effects of Transcranial Electrical Stimulation on Gambling and Gaming: A Systematic Review of Studies on Healthy Controls, Participants with Gambling/Gaming Disorder, and Substance Use Disorder.
Gambling disorder (GD) and internet gaming disorder (IGD) are formally recognized behavioral addictions with a rapidly growing prevalence and limited treatment options. Recently, transcranial electrical stimulation (tES) techniques have emerged as potentially promising interventions for improving treatment outcomes by ameliorating cognitive functions implicated in addictive behaviors. To systematize the current state of evidence and better understand whether and how tES can influence gambling and gaming-related cognitive processes, we conducted a PRISMA-guided systematic review of the literature, focusing on tES effects on gaming and gambling in a diverse range of population samples, including healthy participants, participants with GD and IGD, as well as participants with substance abuse addictions. Following the literature search in three bibliographic databases (PubMed, Web of Science, and Scopus), 40 publications were included in this review, with 26 conducted on healthy participants, 6 focusing on GD and IGD patients, and 8 including participants with other addictions. Most of the studies targeted the dorsolateral prefrontal cortex, using transcranial direct current stimulation (tDCS), and assessed the effects on cognition, using gaming and gambling computerized cognitive tasks measuring risk taking and decision making, e.g., balloon analogue risk task, Iowa gambling task, Cambridge gambling task, etc. The results indicated that tES could change gambling and gaming task performances and positively influence GD and IGD symptoms, with 70% of studies showing neuromodulatory effects. However, the results varied considerably depending on the stimulation parameters, sample characteristics, as well as outcome measures used. We discuss the sources of this variability and provide further directions for the use of tES in the context of GD and IGD treatment.
PubMed: 37240512
DOI: 10.3390/jcm12103407 -
Neurobiology of Pain (Cambridge, Mass.) 2023Chronic pain (CP) is a leading cause of disability worldwide. Pain may be measured using subjective questionnaires, but understanding the underlying physiology, such as... (Review)
Review
INTRODUCTION
Chronic pain (CP) is a leading cause of disability worldwide. Pain may be measured using subjective questionnaires, but understanding the underlying physiology, such as brain function, could improve prognosis. Further, there has been a shift towards cost-effective lifestyle modification for the management of CP.
METHODS
We conducted a systematic review (Registration: #CRD42022331870) using articles retrieved from four databases (Pubmed, EMBASE, AMED, and CINAHL) to assess the effect of exercise on brain function and pain perception/quality of life in adults with CP.
RESULTS
Our search yielded 1879 articles; after exclusion, ten were included in the final review. Study participants were diagnosed with either osteoarthritis or fibromyalgia. However, two studies included "fibromyalgia and low back pain" or "fibromyalgia, back, and complex regional pain." Exercise interventions that were 12 weeks or longer (n = 8/10) altered brain function and improved pain and/or quality of life outcomes. The cortico-limbic pathway, default-mode network, and dorsolateral prefrontal cortex were key regions that experienced alterations post-intervention. All studies that reported an improvement in brain function also demonstrated an improvement in pain perception and/or quality of life.
DISCUSSION
Our review suggests that alterations in brain function, notably the cortico-limbic, default-mode and dorsolateral prefrontal cortex, may be responsible for the downstream improvements in the subjective experience of CP. Through appropriate programming (i.e., length of intervention), exercise may represent a viable option to manage CP via its positive influence on brain health.
PubMed: 37206154
DOI: 10.1016/j.ynpai.2023.100129 -
Neurologia 2023Fibromyalgia syndrome (FM) is a chronic pathology characterised by widespread pain commonly associated with psychological distress affecting quality of life. In recent... (Review)
Review
BACKGROUND
Fibromyalgia syndrome (FM) is a chronic pathology characterised by widespread pain commonly associated with psychological distress affecting quality of life. In recent years, transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) have been investigated to treat chronic pain. The aim of the current review is to determine the effects of tDCS and TMS on the main symptoms of patients with FM.
DEVELOPMENT
A systematic review based on PRISMA guidelines was carried out. The search strategy was performed in MEDLINE, SCOPUS, PEDro and Cochrane Library. Randomised controlled trials based on the effects of tDCS and TMS on pain, pressure pain threshold (PPT), fatigue, anxiety and depression, catastrophising and quality of life in patients with FM were analysed. Fourteen studies were included.
CONCLUSIONS
The application of tDCS to the motor cortex is the only intervention shown to decrease pain in the short and medium-term in patients with FM. The application of both interventions showed improvements in PPT, catastrophising and quality of life when applied to the motor cortex, and in fatigue when applied to the dorsolateral prefrontal cortex. The effects of these interventions on anxiety and depression are unclear.
Topics: Humans; Transcranial Direct Current Stimulation; Transcranial Magnetic Stimulation; Fibromyalgia; Quality of Life; Chronic Pain; Fatigue
PubMed: 37031798
DOI: 10.1016/j.nrleng.2020.07.025 -
Neurological Sciences : Official... Aug 2023To systematically evaluate the impact of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on activities of daily living (ADLs) of patients with... (Meta-Analysis)
Meta-Analysis Review
High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) impacts activities of daily living of patients with post-stroke cognitive impairment: a systematic review and meta-analysis.
OBJECTIVE
To systematically evaluate the impact of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on activities of daily living (ADLs) of patients with post-stroke cognitive impairment (PSCI).
DATA SOURCES
Relevant studies published as of November 2022 (English and Chinese) were searched in Web of Science, PubMed, Embase, Cochrane Library, OVID, China Science and Technology Journal Database (VIP), Wanfang, Chinese National Knowledge Infrastructure (CNKI), and SinoMed databases.
REVIEW METHODS
Randomized controlled trials (RCTs) that used HF-rTMS for the treatment of ADLs in patients with PSCI were included in this meta-analysis. Two reviewers independently screened literature, extracted the data, evaluated the risk of bias using the Cochrane Risk of Bias Tool, and cross-checked.
RESULTS
Forty-one RCTs involving 2855 patients with PSCI were included. In 30 RCTs, the experimental group received HF-rTMS in addition to the interventions used in the control group. In 11 RCTs, the experimental group received HF-rTMS while the control group received sham-rTMS. Barthel Index (BI), Modified Barthel Index (MBI), and Functional Independence Measure (FIM) were higher in the HF-rTMS group than in the control group, whereas scores of Blessed Behavior Scale was lower in the HF-rTMS group than in the control group. All P < 0.05. In 36 studies, the stimulation sites were on the dorsolateral prefrontal cortex (DLPFC).
CONCLUSION
HF-rTMS can ameliorate ADLs of patients with PSCI and has a better rehabilitation effect on PSCI.
Topics: Humans; Activities of Daily Living; Transcranial Magnetic Stimulation; Stroke; Cognitive Dysfunction; China
PubMed: 37012519
DOI: 10.1007/s10072-023-06779-9 -
The Lancet. Psychiatry Apr 2023The left dorsolateral prefrontal cortex is a prime target for repetitive transcranial magnetic stimulation (TMS) to treat neuropsychiatric disorders; thus, abundant... (Meta-Analysis)
Meta-Analysis
Effects of repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex on symptom domains in neuropsychiatric disorders: a systematic review and cross-diagnostic meta-analysis.
BACKGROUND
The left dorsolateral prefrontal cortex is a prime target for repetitive transcranial magnetic stimulation (TMS) to treat neuropsychiatric disorders; thus, abundant efficacy data from controlled trials are available. A cross-diagnostic meta-analysis was conducted to identify the symptom domains susceptible to repetitive TMS to the left dorsolateral prefrontal cortex.
METHODS
This systematic review and meta-analysis investigated the effects of repetitive TMS to the left dorsolateral prefrontal cortex on neuropsychiatric symptoms presenting across diagnoses. We searched PubMed, MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform for randomised and sham controlled trials published from inception to Aug 17, 2022. Included studies assessed symptoms using clinical measures and reported sufficient data to calculate effect sizes pooled with a random effects model. Two independent reviewers conducted screening and used the Cochrane risk-of-bias tool for quality assessment. Summary data were extracted from published reports. The main outcome was the therapeutic effects of repetitive TMS of the left dorsolateral prefrontal cortex on distinct symptom domains. This study is registered with PROSPERO (CRD42021278458).
FINDINGS
Of 9056 studies identified (6704 from databases and 2352 from registers), 174 were included in the analysis including 7905 patients. 163 of 174 studies reported gender data; 3908 (52·35%) of 7465 patients were male individuals, and 3557 (47·65%) were female individuals. Mean age was 44·63 years (range 19·79-72·80). Ethnicity data were mostly not available. Effect size was large for craving (Hedges'g -0·803 [95% CI -1·099 to -0·507], p<0·0001; I=82·40%), medium for depressive symptoms (-0·725 [-0·889 to -0·561], p<0·0001; I=85·66%), small for anxiety, obsessions or compulsions, pain, global cognition, declarative memory, working memory, cognitive control, and motor coordination (Hedges'g -0·198 to -0·491), and non-significant for attention, suicidal ideation, language, walking ability, fatigue, and sleep.
INTERPRETATION
The cross-diagnostic meta-analysis shows the efficacy of repetitive TMS of the left dorsolateral prefrontal cortex on distinct symptom domains, providing a novel framework for assessing target or efficacy interactions of repetitive TMS, and informing personalised applications for conditions for which regular trials are uninformative.
FUNDING
The University Grants Committee of Hong Kong and the Mental Health Research Center, The Hong Kong Polytechnic University.
Topics: Humans; Male; Female; Young Adult; Adult; Middle Aged; Aged; Transcranial Magnetic Stimulation; Dorsolateral Prefrontal Cortex; Pain; Anxiety Disorders; Cognition
PubMed: 36898403
DOI: 10.1016/S2215-0366(23)00026-3 -
Neuroscience Apr 2023Walking is an important function which requires coordinated activity of sensory-motor neural networks. Noninvasive brain stimulation (NIBS) is a safe neuromodulatory... (Review)
Review
BACKGROUND AND OBJECTIVES
Walking is an important function which requires coordinated activity of sensory-motor neural networks. Noninvasive brain stimulation (NIBS) is a safe neuromodulatory technique with motor function-improving effects. This study aimed to determine the effect of different types of NIBS interventions explored in randomized controlled trials on gait in healthy young and older adults.
METHODS
Based on the PRISMA approach, we conducted an electronic search in PubMed, Web of Science, Scopus, and PEDro for randomized clinical trials assessing the effect of NIBS on gait in healthy young and older adults and performed a narrative review.
RESULTS
Fourteen studies were included in this systematic review. According to the outcomes, transcranial direct current stimulation (tDCS) over the motor cortex and transcranial alternating current stimulation (tACS) over the cerebellum seem to be promising for improving gait characteristics such as speed, synchronization, and variability. Furthermore, tDCS over the dorsolateral prefrontal cortex (DLPFC) improved gait speed and reduced gait parameter variability under dual-task conditions. Only one repetitive transcranial magnetic stimulation was available, which showed no effects. No studies were available for transcranial random noise stimulation, and transcranial pulsed current stimulation. Moreover, the intervention parameters of the included studies were heterogeneous, and studies comparing directly specific intervention protocols were missing.
CONCLUSION
NIBS is a promising approach to improve gait in healthy young and older adults. Anodal tDCS over the motor areas and DLPFC, and tACS over the cerebellum have shown positive effects on gait.
Topics: Transcranial Direct Current Stimulation; Transcranial Magnetic Stimulation; Gait; Walking; Cerebellum; Randomized Controlled Trials as Topic
PubMed: 36720301
DOI: 10.1016/j.neuroscience.2023.01.026 -
Biological Psychiatry. Cognitive... Feb 2023Treatments for cognitive dysfunction in neuropsychiatric conditions are urgently needed. Cognitive training and transcranial direct current stimulation (tDCS) hold... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Treatments for cognitive dysfunction in neuropsychiatric conditions are urgently needed. Cognitive training and transcranial direct current stimulation (tDCS) hold promise, and there is growing interest in combined or multimodal treatments, though studies to date have had small samples and inconsistent results.
METHODS
A systematic review and meta-analysis was completed. Retained studies included cognitive training combined with active or sham tDCS in a neuropsychiatric population and reported a posttreatment cognitive outcome. Meta-analyses included effect sizes comparing cognitive training plus active tDCS and cognitive training plus sham tDCS in 5 cognitive domains. Risk of bias in included studies and across studies was explored.
RESULTS
Fifteen studies were included: 10 in neurodegenerative disorders and 5 in psychiatric disorders (n = 629). There were several tDCS montages, though two-thirds of studies placed the anode over the left dorsolateral prefrontal cortex. A wide variety of cognitive training types and outcome measures were reported. There was a small, statistically significant effect of combined treatment on measures of attention/working memory, as well as small and non-statistically significant effects favoring combined treatment on global cognition and language. There was no evidence of bias in individual studies but some evidence of nonreporting or small-study bias across studies.
CONCLUSIONS
These results may provide preliminary support for the efficacy of combined cognitive training and tDCS on measures of attention/working memory. More data are needed, particularly via studies that explicitly align the cognitive ability of interest, stimulation target, training type, and outcome measures.
Topics: Humans; Transcranial Direct Current Stimulation; Cognitive Training; Prefrontal Cortex; Cognition; Memory, Short-Term
PubMed: 36653210
DOI: 10.1016/j.bpsc.2022.09.014