Effects of non-invasive brain stimulation over the supplementary motor area on motor function in Parkinson's disease: A systematic review and meta-analysis

IF 7.6 1区医学 Q1 CLINICAL NEUROLOGY Brain Stimulation Pub Date : 2025-01-01 DOI:10.1016/j.brs.2024.12.005

Yawen Chen , Hanhong Jiang , Yixin Wei , Saiqing Ye , Jiaxin Jiang , Margaret Mak , Marco Y.C. Pang , Qiang Gao , Meizhen Huang

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Abstract

Background

Motor dysfunction profoundly affects individuals with Parkinson's disease (PD). Non-invasive brain stimulation (NIBS) targeting the supplementary motor area (SMA), a critical region for movement-related processing, offers a promising approach to enhance motor function for PD.

Objective

This systematic review and meta-analysis aims to evaluate the efficacy of NIBS over the SMA (SMA-NIBS) in alleviating motor symptoms in PD.

Methods

We conducted literature searches in MEDLINE, EMBASE, Physiotherapy Evidence Database, Web of Science, the Chinese National Knowledge Infrastructure, and Scopus. The meta-analysis utilized an inverse variance method and a random-effects model. Subgroup analyses were performed based on stimulation types (e.g., TMS and tDCS), stimulation protocols (e.g., facilitatory and inhibitory stimulation), and medication status during stimulation.

Results

Twenty randomized control trials involving 442 individuals with PD were included. Compared to sham stimulation, SMA-NIBS significantly improved motor function as measured by the motor section of Unified Parkinson's Disease Rating Scale (UPDRS-III) (mean differences [MD]: −3.45, 95 % confidence interval [CI]: −5.65 to −1.26). Subgroup analysis revealed that only TMS (MD: −3.62, 95%CI: −6.15 to −1.08), not tDCS (MD: −2.47, 95 % CI: −5.03 to 0.08), has significant effect on motor function. Both facilitatory (MD: −2.59, 95 % CI: −3.37 to −1.82) and inhibitory stimulation (MD: −4.98, 95 % CI: −9.29 to −0.66) significantly improved the UPDRS-III score. Effectiveness was observed only during ON medication. Statistically significant effects of SMA-NIBS were reported on Freezing of Gait Questionnaire, not timed up and go test and walking speed.

Conclusion

SMA-NIBS is a promising approach to enhance motor function in PD.

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非侵入性脑刺激辅助运动区对帕金森病运动功能的影响：系统回顾和meta分析

背景：运动功能障碍严重影响帕金森病（PD）患者。针对辅助运动区（SMA）的非侵入性脑刺激（NIBS）为增强PD患者的运动功能提供了一种很有前景的方法。目的：本系统综述和荟萃分析旨在评价NIBS与SMA （SMA-NIBS）相比在缓解PD患者运动症状方面的疗效。方法：在MEDLINE、EMBASE、理疗证据数据库、Web of Science、Chinese National Knowledge Infrastructure和Scopus中进行文献检索。meta分析采用反方差法和随机效应模型。根据刺激类型（如TMS和tDCS）、刺激方案（如促进性和抑制性刺激）和刺激期间的药物状况进行亚组分析。结果：纳入20项随机对照试验，共纳入442例PD患者。通过统一帕金森病评定量表（UPDRS-III）的运动部分测量，与假刺激相比，SMA-NIBS显著改善了运动功能（平均差异[MD]: -3.45, 95%可信区间[CI]: -5.65至-1.26）。亚组分析显示，只有TMS （MD: -3.62, 95%CI: -6.15 ~ -1.08）对运动功能有显著影响，而tDCS （MD: -2.47, 95%CI: -5.03 ~ 0.08）对运动功能没有显著影响。促进性刺激（MD: -2.59, 95% CI: -3.37至-1.82）和抑制性刺激（MD: -4.98, 95% CI: -9.29至-0.66）均显著改善了UPDRS-III评分。仅在ON用药期间观察到有效性。SMA-NIBS对冻结步态问卷、不计时行走和行走速度的影响均有统计学意义。结论：SMA-NIBS是一种很有前景的增强PD患者运动功能的方法。

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来源期刊

Brain Stimulation 医学-临床神经学

CiteScore

13.10

自引率

9.10%

发文量

256

审稿时长

72 days

期刊介绍： Brain Stimulation publishes on the entire field of brain stimulation, including noninvasive and invasive techniques and technologies that alter brain function through the use of electrical, magnetic, radiowave, or focally targeted pharmacologic stimulation. Brain Stimulation aims to be the premier journal for publication of original research in the field of neuromodulation. The journal includes: a) Original articles; b) Short Communications; c) Invited and original reviews; d) Technology and methodological perspectives (reviews of new devices, description of new methods, etc.); and e) Letters to the Editor. Special issues of the journal will be considered based on scientific merit.