Rebecca L D Kan1, Grace X J Xu1, Kate T Shu1, Frank H Y Lai2, Gottfried Kranz3, Georg S Kranz4. 1. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China. 2. Faculty of Health and Life Sciences, The Northumbria University Newcastle, Newcastle upon Tyne, UK. 3. Neurological Rehabilitation Center Rosenhügel, Vienna, Austria. 4. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, 999077, China; Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China.
Abstract
OBJECTIVE: The objective of this meta-analysis was to summarize evidence on the therapeutic effects of non-invasive brain stimulation (NIBS) on core symptoms of multiple sclerosis (MS). Specifically, findings from studies deploying transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) protocols were summarized in this review. METHODS: We systematically searched articles published in four databases, until 31 May 2021, which compared the effects of active tDCS or rTMS with sham intervention in MS patients. We used a random-effects model for this meta-analysis. Meta-regression and subgroup meta-analysis were used to examine the effects of stimulation dose and different stimulation protocols, respectively. RESULTS: Twenty-five randomized controlled trials (RCTs) were included in this review, consisting of 19 tDCS and 6 rTMS studies. tDCS led to a significant and immediate reduction of fatigue with a large effect size (Hedges's g = -0.870, 95% confidence intervals (CI) = [-1.225 to -0.458], number needed to treat (NNT) = 2). Particularly, a subgroup analysis showed that applying tDCS over the left DLPFC and bilateral S1 led to fatigue reductions compared to sham stimulation. Furthermore, tDCS had favorable effects on fatigue in MS patients with low physical disability but not those with high physical disability, and additionally improved cognitive function. Finally, whereas rTMS was observed to reduce muscle spasticity, these NIBS protocols showed no further effect on MS-associated pain and mood symptoms. CONCLUSION: tDCS in MS alleviates fatigue and improves cognitive function whereas rTMS reduces muscle spasticity. More high-quality studies are needed to substantiate the therapeutic effects of different NIBS protocols in MS.
OBJECTIVE: The objective of this meta-analysis was to summarize evidence on the therapeutic effects of non-invasive brain stimulation (NIBS) on core symptoms of multiple sclerosis (MS). Specifically, findings from studies deploying transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) protocols were summarized in this review. METHODS: We systematically searched articles published in four databases, until 31 May 2021, which compared the effects of active tDCS or rTMS with sham intervention in MS patients. We used a random-effects model for this meta-analysis. Meta-regression and subgroup meta-analysis were used to examine the effects of stimulation dose and different stimulation protocols, respectively. RESULTS: Twenty-five randomized controlled trials (RCTs) were included in this review, consisting of 19 tDCS and 6 rTMS studies. tDCS led to a significant and immediate reduction of fatigue with a large effect size (Hedges's g = -0.870, 95% confidence intervals (CI) = [-1.225 to -0.458], number needed to treat (NNT) = 2). Particularly, a subgroup analysis showed that applying tDCS over the left DLPFC and bilateral S1 led to fatigue reductions compared to sham stimulation. Furthermore, tDCS had favorable effects on fatigue in MS patients with low physical disability but not those with high physical disability, and additionally improved cognitive function. Finally, whereas rTMS was observed to reduce muscle spasticity, these NIBS protocols showed no further effect on MS-associated pain and mood symptoms. CONCLUSION: tDCS in MS alleviates fatigue and improves cognitive function whereas rTMS reduces muscle spasticity. More high-quality studies are needed to substantiate the therapeutic effects of different NIBS protocols in MS.
Authors: Marco Tramontano; Maria Grazia Grasso; Silvia Soldi; Elias Paolo Casula; Sonia Bonnì; Sara Mastrogiacomo; Alessia D'Acunto; Francesco Porrazzini; Carlo Caltagirone; Giacomo Koch Journal: Cerebellum Date: 2020-12 Impact factor: 3.847
Authors: Matthew J Page; Joanne E McKenzie; Patrick M Bossuyt; Isabelle Boutron; Tammy C Hoffmann; Cynthia D Mulrow; Larissa Shamseer; Jennifer M Tetzlaff; Elie A Akl; Sue E Brennan; Roger Chou; Julie Glanville; Jeremy M Grimshaw; Asbjørn Hróbjartsson; Manoj M Lalu; Tianjing Li; Elizabeth W Loder; Evan Mayo-Wilson; Steve McDonald; Luke A McGuinness; Lesley A Stewart; James Thomas; Andrea C Tricco; Vivian A Welch; Penny Whiting; David Moher Journal: BMJ Date: 2021-03-29
Authors: Małgorzata Szcześniak; Andrzej Potemkowski; Waldemar Brola; Zdzisław Kroplewski; Roman Ryszard Szałachowski; Marek Zak; Maciej Wilski; Piotr Sobolewski; Halina Bartosik-Psujek; Katarzyna Kapica-Topczewska; Joanna Tarasiuk; Agata Czarnowska; Alina Kułakowska; Beata Zakrzewska-Pniewska; Katarzyna Kubicka-Bączyk; Natalia Morawiec; Monika Adamczyk-Sowa; Adam Stępień; Jacek Zaborski; Anna Ratajczak; Marcin Ratajczak Journal: Int J Environ Res Public Health Date: 2022-04-29 Impact factor: 4.614