Low Frequency Repetitive Transcranial Magnetic Stimulation For Post-stroke Depression: Systematic Review And Meta-analysis

Background:According to the Global Burden of Disease Study 2019,the incidence rate of stroke in China is 276.7/100,000,which is significantly higher than the global average.Post-stroke depression,the most frequent psychological disorder in stroke patients,is characterized by symptoms such as low mood and a lack of motivation.This disease not only impedes the recovery of neurological function and cognition,but also increases the mortality of stroke patients.Therefore,early treatment for patients with post-stroke depression can better restore neurological function and improve the quality of life.Objective:A Meta-analysis of the study is to be conducted to further investigate the efficacy and safety of low-frequency repetitive transcranial magnetic stimulation on post-stroke depression.Methods:Computer searches of the databases of China National Knowledge Infrastructure,Wanfang,China Biomedical Abstraction Database,VIP,Pub Med,Embase,Web of Science,MEDLINE and the Cochrane Library were conducted from January1,2000 to June 1,2022.In accordance with the established criteria for inclusion and exclusion,eligible randomized control trials were screened.Data extraction was performed on the included literatures meeting the criteria.The literature’s quality was assessed through the utilization of Review Manager 5.3 software,while Stata 14.0 was employed for data analysis.Continuous variables were described with standardized mean difference and 95%confidence intervals.Dichotomous variables were depicted as odds ratio with 95%confidence intervals.I~2was used to evaluate the heterogeneity.When I~2>50%,the heterogeneity was high,prompting sensitivity analysis and subgroup analysis to uncover the sources of it.Moreover,Egger test and funnel plot were employed to systematically assess publication bias in articles.Results:This Meta-analysis encompassed 28 articles,comprising 28randomized controlled trials with 2046 participants,1024 of whom were in the experimental group and 1022 in the control group.The quality of the included studies was appraised using seven quality evaluation indicators,of which 5 were of moderate quality,23 were of high quality.For the improvement of depressive symptoms:(1)the change of HAMD score:the results indicated that,in comparison to the control group,a more significant decrease in HAMD score was observed after low-frequency repetitive transcranial magnetic stimulation(SMD=-1.01,95%CI=-1.20--0.82,I~2=73.2%,P<0.001).Sensitivity analysis showed that the conclusion had strong stability.The results of subgroup analysis showed that the previous conclusion still held true in all subgroup analyses with more than one included study.The Egger test and funnel plot(p=0.650,95%CI=-4.391169-2.798636)verified that there was no substantial publication bias in this result,and the conclusion was dependable.(2)Changes of other scales:Meta-analysis of 4 studies using SDS showed that SDS scores decreased more significantly after low-frequency repetitive transcranial magnetic stimulation(SMD=-1.07,95%CI=-1.27--0.87,I~2=0.0%,P=0.807).Meta-analysis of two studies using BDI showed that there was no significant difference in BDI scores after low-frequency repetitive transcranial magnetic stimulation(SMD=-0.81,95%CI=-3.00-1.38,I~2=90.5%,P=0.001).For the recovery of neurological function:(1)For the change of ADL score:Meta-analysis results revealed that,in comparison to the control group,the ADL score increased more significantly after low-frequency repetitive transcranial magnetic stimulation(SMD=1.60,95%CI=0.94-2.26,I~2=94.7%,P<0.001).Sensitivity analysis showed that the conclusion had relatively strong stability.The results of subgroup analysis showed that the previous conclusion still held in all subgroup analyses with more than one included study.Funnel plot and Egger test(p=0.876,95%CI=-12.39209-10.7055)confirmed that there was no significant publication bias in this result,and the conclusion was reliable.(2)For the change of NIHSS score:Meta-analysis of 5 studies using NIHSS showed that the reduction of NIHSS score after low-frequency repetitive transcranial magnetic stimulation was more significant (SMD=-0.31,95%CI=-0.55--0.07,I2=0.0%,P=0.636).(3)For the changes of MMSE:Meta-analysis of 7 studies using MMSE showed that MMSE scores increased more significantly after low-frequency repetitive transcranial magnetic stimulation(SMD=0.88,95%CI=0.52-1.24,I~2=78.1%,P<0.001).For the incidence of adverse reactions,Meta-analysis showed that only 9 studies had adverse reactions such as headache after low-frequency repetitive transcranial magnetic stimulation,and there was no statistically significant difference(OR=1.99,95%CI=0.47-8.42,I~2=71.9%,P<0.001).Conclusions:The efficacy of low-frequency repetitive transcranial magnetic stimulation in treating depressive symptoms in those suffering from post-stroke depression is undeniable.At the same time,it also plays a crucial role in the recovery of neurological function in these patients.Furthermore,Low-frequency repetitive transcranial magnetic stimulation has few adverse reactions and acceptable safety.