Article

Several studies have reported repetitive transcranial magnetic
stimulation (rTMS) therapy as an effective treatment for the control of motor
symptoms in Parkinson disease. The objective of the study is to quantify the
overall efficacy of this treatment. TYPES: Systematic review and meta-analysis.
LITERATURE SURVEY: We reviewed the literature on clinical rTMS trials in
Parkinson disease since the technique was introduced in 1980. We used the
following databases: MEDLINE, Web of Science, Cochrane, and CINAHL. METHODOLOGY:
PATIENTS AND SETTING: Patients with Parkinson disease who were participating in
prospective clinical trials that included an active arm and a control arm and
change in motor scores on Unified Parkinson's Disease Rating Scale as the primary
outcome. We pooled data from 21 studies that met these criteria. We then analyzed
separately the effects of low- and high-frequency rTMS on clinical motor
improvements. SYNTHESIS: The overall pooled mean difference between treatment and
control groups in the Unified Parkinson's Disease Rating Scale motor score was
significant (4.0 points, 95% confidence interval, 1.5, 6.7; P = .005). rTMS
therapy was effective when low-frequency stimulation (</=1 Hz) was used with a
pooled mean difference of 3.3 points (95% confidence interval 1.6, 5.0; P =
.005). There was a trend for significance when high-frequency stimulation (>/=5
Hz) studies were evaluated with a pooled mean difference of 3.9 points (95%
confidence interval, -0.7, 8.5; P = .08). rTMS therapy demonstrated benefits at
short-term follow-up (immediately after a treatment protocol) with a pooled mean
difference of 3.4 points (95% confidence interval, 0.3, 6.6; P = .03) as well as
at long-term follow-up (average follow-up 6 weeks) with mean difference of 4.1
points (95% confidence interval, -0.15, 8.4; P = .05). There were insufficient
data to statistically analyze the effects of rTMS when we specifically examined
bradykinesia, gait, and levodopa-induced dyskinesia using quantitative methods.
CONCLUSION: rTMS therapy in patients with Parkinson disease results in
mild-to-moderate motor improvements and has the potential to be used as an
adjunct therapy for the treatment of Parkinson disease. Future large, sample
studies should be designed to isolate the specific clinical features of Parkinson
disease that respond well to rTMS therapy.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS