Alireza Emadi, Sara Halakoo, Cyrus Taghizadeh Delkhoush, F. Ehsani
{"title":"The Effects of Neuromodulators on Spasticity, Balance, and Gait in Patients with MS: A Systematic Review and Meta-Analysis Study","authors":"Alireza Emadi, Sara Halakoo, Cyrus Taghizadeh Delkhoush, F. Ehsani","doi":"10.1159/000528100","DOIUrl":null,"url":null,"abstract":"Introduction: Multiple sclerosis (MS) is a common neurological disorder in societies. The most common symptoms in patients with MS are gait disorders and spasticity. Pharmacological therapies have mild therapeutic influence with more side effects for management of these symptoms. There is evidence that neuro-rehabilitation techniques have more appropriate effects rather than pharmacological therapies. In this regard, some studies indicated the beneficial effects of brain stimulation techniques on gait improvement and decreasing spasticity in patients with MS, while the others have not shown any efficacy. Accordingly, conducting a meta-analysis study in this issue is very important. Methods: A systematic search was performed in PubMed, Scopus, and ISI Web of Science from database inception on December 6, 2020, to find interventional studies assessing the effects of neuromodulators (transcranial direct-current stimulation [tDCS] or transcranial magnetic stimulation [TMS]) on spasticity, balance, and gait in patients with MS. The included studies were qualitatively assessed by the Physiotherapy Evidence Database (PEDro) scale. Finally, the homogeneity studies were analyzed by Stata software. Study-specific results were pooled by using a random-effects model. Results: A total of seven studies were included in the analysis. In the pooled analysis of studies, a significant effect of the TMS technique on spasticity was observed in patients with MS: −0.80 (95% CI: −1.31, −0.29). In addition, no significant effect of the single-session tDCS technique on gait speed was observed in patients with MS: 0.11 (95% CI: −0.11, 0.32). Conclusions: One of the main causes of discrepancy in the findings of included studies is the number of sessions for using neuromodulator techniques. A single session of anodal tDCS is not enough to improve gait in patients with MS. In addition, meta-analysis shows that multi-session TMS is effective intervention for decreasing spasticity in patients with MS.","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":"216 ","pages":"144 - 154"},"PeriodicalIF":2.1000,"publicationDate":"2023-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000528100","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 1
Abstract
Introduction: Multiple sclerosis (MS) is a common neurological disorder in societies. The most common symptoms in patients with MS are gait disorders and spasticity. Pharmacological therapies have mild therapeutic influence with more side effects for management of these symptoms. There is evidence that neuro-rehabilitation techniques have more appropriate effects rather than pharmacological therapies. In this regard, some studies indicated the beneficial effects of brain stimulation techniques on gait improvement and decreasing spasticity in patients with MS, while the others have not shown any efficacy. Accordingly, conducting a meta-analysis study in this issue is very important. Methods: A systematic search was performed in PubMed, Scopus, and ISI Web of Science from database inception on December 6, 2020, to find interventional studies assessing the effects of neuromodulators (transcranial direct-current stimulation [tDCS] or transcranial magnetic stimulation [TMS]) on spasticity, balance, and gait in patients with MS. The included studies were qualitatively assessed by the Physiotherapy Evidence Database (PEDro) scale. Finally, the homogeneity studies were analyzed by Stata software. Study-specific results were pooled by using a random-effects model. Results: A total of seven studies were included in the analysis. In the pooled analysis of studies, a significant effect of the TMS technique on spasticity was observed in patients with MS: −0.80 (95% CI: −1.31, −0.29). In addition, no significant effect of the single-session tDCS technique on gait speed was observed in patients with MS: 0.11 (95% CI: −0.11, 0.32). Conclusions: One of the main causes of discrepancy in the findings of included studies is the number of sessions for using neuromodulator techniques. A single session of anodal tDCS is not enough to improve gait in patients with MS. In addition, meta-analysis shows that multi-session TMS is effective intervention for decreasing spasticity in patients with MS.
引言：多发性硬化症是社会中常见的神经系统疾病。MS患者最常见的症状是步态障碍和痉挛。药物治疗对这些症状的治疗影响较小，副作用较多。有证据表明，神经康复技术比药物疗法具有更合适的效果。在这方面，一些研究表明，脑刺激技术对多发性硬化症患者步态改善和减少痉挛有有益影响，而其他研究则没有显示出任何疗效。因此，在这个问题上进行荟萃分析研究是非常重要的。方法：自2020年12月6日数据库建立以来，在PubMed、Scopus和ISI Web of Science上进行了系统搜索，以寻找评估神经调节剂（经颅直流电刺激[tDCS]或经颅磁刺激[TMS]）对MS患者痉挛、平衡和步态影响的介入研究。纳入的研究通过物理治疗证据数据库（PEDro）量表进行了定性评估。最后，利用Stata软件对同质性研究进行了分析。通过使用随机效应模型汇总研究的具体结果。结果：共有7项研究被纳入分析。在研究的汇总分析中，在MS患者中观察到TMS技术对痉挛的显著影响：-0.80（95%CI:−1.31，−0.29）。此外，在MS患者中，未观察到单次tDCS技术对步态速度的显著影响：0.11（95%CI:-0.11，0.32）。结论：纳入研究结果不一致的主要原因之一是使用神经调节器技术的次数。单次阳极tDCS不足以改善MS患者的步态。此外，荟萃分析表明，多次TMS是减少MS患者痉挛的有效干预措施。
期刊介绍：
''European Neurology'' publishes original papers, reviews and letters to the editor. Papers presented in this journal cover clinical aspects of diseases of the nervous system and muscles, as well as their neuropathological, biochemical, and electrophysiological basis. New diagnostic probes, pharmacological and surgical treatments are evaluated from clinical evidence and basic investigative studies. The journal also features original works and reviews on the history of neurology.
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