ObjectiveTo evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on unilateral spatial neglect in stroke patients. MethodsPublished articles from the earliest date available to July, 2016 were recalled from PubMed, OVID, Embase, Cochrane Library, CNKI, VIP and Wanfang Database. Two reviewers selected independently the randomized controlled trials (RCTs) about rTMS for stroke patients with unilateral spatial neglect, and extracted data independently and analyzed with RevMan 5.3 and GRADE profiler 3.6. ResultsTwelve trials that represented 353 participants were evaluated. For improving Line Bisection Test, Star Cancellation Test, Albert Test, rTMS groups were significantly more effective than the controls. rTMS groups with different frequencies all showed significantly effective: for low frequency rTMS, SMD=-1.21, 95%CI=-2.17 to -0.25; for high frequency rTMS, SMD=-2.56, 95%CI=-3.54 to -1.58; for continuous theta burst stimulation (cTBS), SMD=-2.51, 95%CI=-3.66 to -1.36. ConclusionrTMS is effective on unilateral spatial neglectin in stroke patients.
[1] 王芗斌,陈晓春,宋为群. 经颅磁刺激技术治疗偏侧忽略的研究进展[J]. 中国康复医学杂志, 2005, 20(9): 715-718.
[2] Kim M, Na DL, Kim GM, et al. Ipsilesional neglect: behavioural and anatomical features [J]. J Neurol Neurosurg Psychiatry, 1999, 67(1): 35-38.
[3] Rengachary J, He BJ, Shulman GL, et al. A behavioral analysis of spatial neglect and its recovery after stroke [J]. Front Human Neurosci, 2011, 5(6): 394-405.
[4] Karnath HO, Rennig J, Johannsen L, et al. The anatomy underlying acute versus chronic spatial neglect: a longitudinal study [J]. Brain A J Neurol, 2011, 134(3): 903-912.
[5] Jehkonen M, Laihosalo M, Kettunen JE. Impact of neglect on functional outcome after stroke: a review of methodological issues and recent research findings [J]. Restor Neurol Neurosci, 2006, 24(4-6): 209-215.
[6] Kopp B, Kunkel A, Muhlnickel W. Plasticity in the motor system related to therapy-induced improvement of movement after stroke [J]. Clin Neurosci, 1999, 10(4): 807-810.
[7] Dijkerman HC, Ietswarrt M, Johnston M. Does motor imagery training improve hand function in chronic stroke patient ? A pilot study [J]. Clinical Rehabil, 2004, 18(5): 538-549.
[8] Pandian JD, Arora R, Kaur P, et al. Mirror therapy in unilateral neglect after stroke (MUST trial): a randomized controlled trial [J]. Neurology, 2014, 83(11): 1012-1017.
[9] Cazzoli D, Müri RM, Hess CW, et al. Treatment of hemispatial neglect by means of rTMS–a review [J]. Restor Neurol Neurosci, 2010, 28(4): 499-510.
[10] 王晓明,谢建平,周树舜. 重复经颅磁刺激技术及其临床应用进展[J]. 国外医学物理医学与康复学分册, 2004, 24(1): 43-45.
[11] 张艳明,付伟,胡洁,等. 经颅磁刺激对卒中后患者视觉空间忽略作用机制的研究进展[J]. 中国脑血管病杂志, 2012, 9(6): 323-326.
[12] Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions [M]. New Jersey: Wiley-Blackwell, 2008.
[13] Hguyatt G, Doxman A, Jschnemann H, et al. GRADE guidelines: A new series of articles in the Journal of Clinical Epidemiology [J]. J Clin Epidemiol, 2011, 64(4): 380-382.
[14] Cha HG, Kim MK. Effects of repetitive transcranial magnetic stimulation on arm function and decreasing unilateral spatial neglect in subacute stroke: A randomized controlled trial [J]. Clin Rehabil, 2015, 55(20): 4606-4610.
[15] Cha HG, Kim MK. The effects of repetitive transcranial magnetic stimulation on unilateral neglect of acute stroke patients: A randomised controlled trial [J]. Hong Kong Physiother J, 2015, 33(2): 53-58.
[16] Fu W. Long-term effects of continuous theta-burst stimulation in visuospatial neglect [J]. J Int Med Res, 2015, 43(2): 196-203.
[17] Yang W, Liu TT, Song XB, et al. Comparison of different stimulation parameters of repetitive transcranial magnetic stimulation for unilateral spatial neglect in stroke patients [J]. J Neurol Sci, 2015, 359(1-2): 219-225.
[18] Bo RK, Min HC, Kim DY, et al. Effect of high- and low-frequency repetitive transcranial magnetic stimulation on visuospatial neglect in patients with acute sroke: a double-blind, sham-controlled Trial [J]. Arch Phys Med Rehabil, 2013, 94(5): 803-807.
[19] Koch G, Bonni S, Giacobbe V, et al. Theta-burst stimulation of the left hemisphere accelerates recovery of hemispatial neglect [J]. Neurology, 2012, 78(1): 24-30.
[20] Song W, Du B, Xu Q, et al. Low-frequency transcranial magnetic stimulation for visual spatial neglect: a pilot study [J]. J Rehabil Med, 2009, 41(3): 162-165.
[21] 王永慧,杨广军,董磊. 脑卒中后单侧空间忽略对患者运动功能恢复的影响[J]. 河北医药, 2015, 37(16): 2476-2479.
[22] 王永慧,杨广军,董磊. 经颅磁刺激对脑卒中后单侧空间忽略患者运动功能康复的作用[J]. 医学临床研究, 2014, 31(5): 876-878.
[23] 张艳明,付伟,胡洁,等. 行为学疗法联合重复经颅磁刺激治疗脑卒中后偏侧空间忽略的疗效观察[J]. 中华物理医学与康复杂志, 2012, 34(12): 915-917.
[24] 何静杰,刘丽旭,公维军,等. 低频重复经颅磁刺激治疗半侧空间忽略的临床研究[J]. 中国康复理论与实践, 2011, 17(7): 640-643.
[25] 胡洁,杜博琪,岳月红,等. 重复经颅磁刺激的累积效应在治疗偏侧忽略中的作用研究[J]. 中国康复医学杂志, 2010, 25(4): 311-314.
[26] Guyatt GH, Oxman AD, Kunz R, et al. Going from evidence to recommendations [J]. BMJ, 2008, 336(7652): 1049-1051.
[27] Guyatt GH, Oxman AD, Kunz R, et al. Incorporating considerations of resources use into grading recommendations [J]. BMJ, 2008, 336(7654): 1170-1173.
[28] Guyatt GH, Oxman AD, Kunz R, et al. What is “quality of evidence” and why is it important to clini-cians? [J]. BMJ, 2008, 336(7651): 995-998.
[29] Jaeschke R, Guyatt GH, Dellinger P, et al. Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive [J]. BMJ, 2008, 337: a744.
[30] Schünemann HJ, Oxman AD, Brozek J, et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies [J]. BMJ, 2008, 336(7653): 1106-1110.
