Highlights
- •This systematic review provides comprehensive evidence of the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) for treatment of poststroke depression (PSD).
- •Findings from this review reveal that HF-rTMS improves depression, response rates, remission rates, stroke severity, and activities of daily living in patients with PSD.
- •Aside from headaches, we found no significant differences in the incidence of other adverse events between the HF-rTMS group and the control group.
Abstract
Objective
To summarize and systematically review the efficacy and safety of high-frequency repetitive
transcranial magnetic stimulation (HF-rTMS) for depression in patients with stroke.
Data Sources
Six databases (Wanfang, the China National Knowledge Infrastructure, PubMed, Embase,
Cochrane Library, and Web of Science) were searched from inception until November
15, 2018.
Study Selection
Seventeen randomized controlled trials were included for meta-analysis.
Data Extraction
Two independent reviewers selected potentially relevant studies based on the inclusion
criteria, extracted data, and evaluated the methodological quality of the eligible
trials using the Physiotherapy Evidence Database.
Data Synthesis
We calculated the combined effect size (standardized mean difference [SMD] and odds
ratio [OR]) for the corresponding effects models. Physiotherapy Evidence Database
scores ranged from 7 to 8 points (mean=7.35). The study results indicated that HF-rTMS
had significantly positive effects on depression in patients with stroke. The effect
sizes of the SMD ranged from small to large (SMD, -1.01; 95% confidence interval [CI],
-1.36 to -0.66; P<.001; I2, 85%; n=1053), and the effect sizes of the OR were large (response rates, 58.43%
vs 33.59%; OR, 3.31; 95% CI, 2.25-4.88; P<.001; I2, 0%; n=529; remission rates, 26.59% vs 12.60%; OR, 2.72; 95% CI, 1.69-4.38; P<.001; I2, 0%; n=529). In terms of treatment side effects, the HF-rTMS group was more prone
to headache than the control group (OR, 3.53; 95% CI, 1.85-8.55; P<.001; I2, 0%; n=496).
Conclusions
HF-rTMS is an effective intervention for poststroke depression, although treatment
safety should be further verified via large sample multicenter trials.
Keywords
List of abbreviations:
ADL (activities of daily living), BI (Barthel Index), CI (confidence interval), HAM-D (Hamilton Depression Rating Scale), HF-rTMS (high-frequency repetitive transcranial magnetic stimulation), NIHSS (National Institute of Health Stroke Scale), OR (odds ratio), PSD (poststroke depression), RCT (randomized controlled trial), rTMS (repetitive transcranial magnetic stimulation), SMD (standardized mean difference)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 16, 2019
Footnotes
Supported by the Science and Technology Plan of the Xinjiang Production and Construction Corps in the Xinjiang Uygur Autonomous Region of China (grant no. 2012BA023).
Clinical Trial Registration No.: CRD42018098789
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
