ObjectiveTo systematically review the efficacy of different stimulation modalities of repetitive transcranial magnetic stimulation (rTMS) combined with SSRI in improving depressed mood after stroke using network meta-analysis. MethodsThe PubMed, EMbase, Cochrane Library, Web of Science, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to October 1, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Network meta-analysis was then performed by using R 4.2.1software. ResultsA total of 25 RCTs involving 2 152 patients were included. Four types of rTMS stimulation combined with SSRIs were included: high-frequency stimulation of the left dorsolateral prefrontal (l-DLPFC), low-frequency stimulation of l-DLPFC, low-frequency stimulation of the right dorsolateral prefrontal (r-DLPFC), and low-frequency stimulation of the bilateral DLPFC. The results of the network meta-analysis showed that the effect of combining four stimulation methods with SSRI in treating depression was better than that of SSRI alone (P<0.05). Probability sorting results showed that low-frequency stimulated bilateral DLPFC (88.9%) > low-frequency stimulated l-DLPFC (63.1%) > high-frequency stimulation l-DLPFC (57.1%) > low-frequency stimulation r-DLPFC (40.4%). There was no statistically significant difference in the incidence of adverse reactions between the four stimulation methods combined with SSRI and the use of SSRI alone (P>0.05). Conclusion rTMS combined with SSRIs is better than SSRIs alone in improving depressed mood after stroke. Low-frequency rTMS stimulation of bilateral DLPFC may be the best. Meanwhile, the safety of different stimulation methods is good.
Objective To evaluate the systematic reviews of repetitive transcranial magnetic stimulation (rTMS) for insomnia, to provide supporting evidence for clinical practice. Methods PubMed, Embase, Web of Science, Cochrane Library, Elsevier Science Direct, China National Knowledge Infrastructure, SinoMed, Wanfang and Chongqing VIP were searched from databases establishment to May 30, 2022, to find systematic reviews on the treatment of insomnia with rTMS as the main method. The methodological quality, reporting quality and evidence quality of outcome indicators were evaluated by AMSTAR 2, PRISMA 2020 and GRADE. Results A total of 4 systematic reviews published between 2018 and 2021 were included. Further analysis showed that one of the systematic reviews had a low AMSTAR 2 quality rating and the remaining systematic reviews were very low. The average PRISMA 2020 score of these 4 systematic reviews was (20.75±3.27) points, of which 3 systematic reviews had some defects in their reports, and the other one had relatively complete reports. The GRADE evidence quality assessment showed that there were 40 outcome indicators in the included literature, of which 3 outcome indicators (sleep quality, the percentage of S2 sleep in total sleep time, and S3 sleep in percentage of total sleep time) were rated as moderate, 17 were rated as low and 20 were rated as very low. Conclusions The treatment of insomnia by rTMS has achieved certain effects in clinical practice, but the systematic review of rTMS as the main intervention measure for insomnia needs to further improve the quality and standardize related research. The clinical application of rTMS for insomnia should be treated as appropriate.
ObjectiveTo observe the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) applied at contralesional hemisphere Broca’s homologue on patients with global aphasia after left massive cerebral infarction. Methods Patients with global aphasia after left massive cerebral infarction in the Department of Neurorehabilitation of China Rehabilitation Research Center between August 2021 and December 2023 were selected. According to the random number table method, patients were randomly divided into a low-frequency rTMS group and a high-frequency rTMS group. rTMS targeted the mirror area within the right hemispheric Broca’s area. Patients’ language ability was assessed pre- and post-treatment by the Chinese version of the western aphasia battery (WAB). Results A total of 27 patients were included, with 14 in the low-frequency rTMS group and 13 in the high-frequency rTMS group. Before treatment, there was no statistically significant difference in the WAB test indicators between the two groups of patients (P>0.05). After treatment, WAB scores (spontaneous speech, auditory comprehension, naming, repetition, aphasia quotients) in both groups were significantly improved (P<0.05); compared to the low-frequency rTMS group, the high-frequency rTMS group exhibited significant improvement in spontaneous speech, auditory comprehension, repetition, naming and aphasia quotients (P<0.05). Conclusion The effect of high-frequency rTMS excitation to contralesional hemisphere is better than that of conventional low-frequency rTMS inhibition to contralesional hemisphere in improving the speech function of patients with global aphasia after left massive cerebral infarction.
Repeated transcranial magnetic stimulation (rTMS) is one of the commonly used brain stimulation techniques. In order to investigate the effects of rTMS on the excitability of different types of neurons, this study is conducted to investigate the effects of rTMS on the cognitive function of mice and the excitability of hippocampal glutaminergic neurons and gamma-aminobutyric neurons from the perspective of electrophysiology. In this study, mice were randomly divided into glutaminergic control group, glutaminergic magnetic stimulation group, gamma-aminobutyric acid energy control group, and gamma-aminobutyric acid magnetic stimulation group. The four groups of mice were injected with adeno-associated virus to label two types of neurons and were implanted optical fiber. The stimulation groups received 14 days of stimulation and the control groups received 14 days of pseudo-stimulation. The fluorescence intensity of calcium ions in mice was recorded by optical fiber system. Behavioral experiments were conducted to explore the changes of cognitive function in mice. The patch-clamp system was used to detect the changes of neuronal action potential characteristics. The results showed that rTMS significantly improved the cognitive function of mice, increased the amplitude of calcium fluorescence of glutamergic neurons and gamma-aminobutyric neurons in the hippocampus, and enhanced the action potential related indexes of glutamergic neurons and gamma-aminobutyric neurons. The results suggest that rTMS can improve the cognitive ability of mice by enhancing the excitability of hippocampal glutaminergic neurons and gamma-aminobutyric neurons.
In order to explore effective ways to reduce non-suicidal self-injury (NSSI) among female adolescents, a total of 45 female adolescent patients with NSSI in West China Hospital of Sichuan University and Guizhou Second Provincial People's Hospital from June 2021 to June 2024 were selected randomly that divided into groups A, B and C, with 15 cases in each group. Group A was treated with repeated transcranial magnetic stimulation (rTMS) and bipolar depression triple therapy, and group B was treated with bipolar depression triple therapy to compare the effectiveness and safety. Group C received bipolar depression triple therapy combined with sham stimulation which only produced stimulating sounds but no stimulating magnetic field as a control in the study. After treatment, the Hamilton Anxiety Score (HAMA), Hamilton Depression Score (HAMD) and Nurses’ Global Assessment of Suicide Risk (NGASR) in group A were significantly lower than those in group B and C (P < 0.01). rTMS combined with bipolar depression triple therapy has a definite effect on reducing NSSI in female adolescents, which can reduce the incidence rate of short-term NSSI behavior in patients.
Transcranial magnetic stimulation (TMS) as a noninvasive neuromodulation technique can improve the impairment of learning and memory caused by diseases, and the regulation of learning and memory depends on synaptic plasticity. TMS can affect plasticity of brain synaptic. This paper reviews the effects of TMS on synaptic plasticity from two aspects of structural and functional plasticity, and further reveals the mechanism of TMS from synaptic vesicles, neurotransmitters, synaptic associated proteins, brain derived neurotrophic factor and related pathways. Finally, it is found that TMS could affect neuronal morphology, glutamate receptor and neurotransmitter, and regulate the expression of synaptic associated proteins through the expression of brain derived neurotrophic factor, thus affecting the learning and memory function. This paper reviews the effects of TMS on learning, memory and plasticity of brain synaptic, which provides a reference for the study of the mechanism of TMS.
Repetitive transcranial magnetic stimulation(rTMS) is a painless and non-invasive method for stimulation and modulation in the field of cognitive neuroscience research and clinical neurological regulation. In this paper, adult Wistar rats were divided into the rTMS group and control group randomly. Rats in the rTMS group were stimulated with 5 Hz rTMS for 14 days, while the rats in the control group did not accept any stimulation. Then, the behavior and local field potentials (LFPs) were recorded synchronously when the rats perform a working memory (WM) task with T-maze. Finally, the time-frequency distribution and coherence characteristics of the LFPs signal in the prefrontal cortex (PFC) during working memory task were analyzed. The results showed that the rats in the rTMS group needed less training days to reach the task correction criterion than the control group (P < 0.05). Compared with the control group, the rTMS group has higher energy (P < 0.01) in θ band (4~12 Hz) and γ band (30~80 Hz). The coherence between the channel pairs decreases as the spatial distance of the channel pairs increases, and the rTMS group exhibits a higher coherence than the control group (P < 0.01). It is concluded that 5 Hz rTMS can improve the excitability of rat prefrontal cortical neurons to a certain extent, and has a positive effect on the working memory ability of normal rats. The results of this paper may provide important theoretical support for further research on the mechanism of action of rTMS on WM.
Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating stroke patients with motor dysfunction. Methods The Cochrane Library, MEDLINE, EMbase, CBM, CNKI and WanFang Data were searched from inception to January 2012, and the references of the included studies were also retrieved to collect the randomized controlled trials (RCTs) on rTMS in treating stroke patients with motor dysfunction. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0.2 software, and evidence quality and recommendation level were assessed using the GRADE system. Results A total of 11 RCTs involving 376 patients were included. The results of meta-analysis (including 3 RCTs, low quality) showed that, compared with the routine rehabilitation treatment, 2 to 4 weeks of rTMS was much beneficial to stroke patients with motor dysfunction, with significant differences (WMD=11.02, 95%CI 2.56 to 19.47). The other 8 studies only adopted descriptive analysis accordingly. Conclusion It is still uncertain of the effectiveness of rTMS in improving motor dysfunction of stroke patients, so rTMS should be applied with caution in clinic.
Non-invasive brain stimulation is a technology that uses magnetic field or electric field to act on the brain to adjust the activity of cerebral cortex neurons. It mainly includes transcranial magnetic stimulation and transcranial direct current stimulation. The principle is to accelerate the induction of neuroplasticity by changing the excitability of the cerebral cortex. The characteristics are noninvasive, safe and that the patient can tolerate it. This article mainly introduces the theoretical foundation and mechanisms of non-invasive brain stimulation, and its application and safety in stroke complications, neuropathic pain and epilepsy, and discusses the commonly used treatment regimens of non-invasive brain stimulation in different neurological diseases, in order to provide possible treatment reference for the rehabilitation of neurological diseases.
ObjectiveTo systematically evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on post-stroke depression (PSD).MethodsWe searched databases including the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet, Wanfang, China Biology Medicine database and VIP database to collect randomized controlled trials comparing the effect of the rTMS group and the control group with the scores of depression scale from January 2013 to April 2018. Patients in the rTMS group received rTMS plus drug therapy or conventional treatment for PSD, and patients in the control group received rTMS sham stimulation or not, but the drug treatment or routine treatment was required. When the quality evaluation and data extraction were carried out by two reviewers independently, the Meta-analysis was performed using RevMan 5.3 software and Stata 14.0 software.ResultsA total of 18 literatures involving 1 376 patients (687 patients in the rTMS group and 689 patients in the control group) with PSD were included in this Meta-analysis. Compared with the control group, the rTMS group could effectively reduce the depression scores of PSD patients [standard mean difference (SMD)=–1.13, 95% confidence interval (CI) (–1.42, –0.84), P<0.000 01], and the effective rate of rTMS was 91.7%; meanwhile, rTMS could promote the scores of the National Institute of Health Stroke Scale and the activities of daily living of patients with PSD [SMD=–1.00, 95%CI (–1.25, –0.75), P<0.000 01;SMD=1.56, 95%CI (0.80, 2.32), P<0.000 01]. The source of heterogeneity was not found according to subgroup analysis and Meta-regression analysis. Additionally, few studies reported adverse reactions after the treatment of rTMS.ConclusionsrTMS has a positive effect on depression, neurological deficits, and decreased ability of daily living in patients with PSD. Due to the quality of the included studies, the conclusions need to be verified further.