| Objectives: The purpose of this systematic review was to evaluate the clinical efficacy of various types of non-invasive brain stimulation(NIBS)methods for the treatment of hereditary ataxia by using evidence-based medicine methods.We aimed to find out the optimal NIBS methods and stimulation protocol.In addition,the efficacy of low-frequency repetitive transcranial magnetic stimulation(r TMS)in 8patients with spinocerebellar ataxia(SCA)for 10 consecutive days was also observed.Methods: A systematic literature research for both English and Chinese articles was conducted from Cochrane Central Register of Controlled Trails,Pub Med database,Web of science,EMBASE,Chinese National Knowledge Infrastructure(CNKI),China Biology Medicinedisc(CBMdisc),Chinese Science and Technique Journals Database(VIP)and Wanfang Database up to March 2023.The original articles investigating the therapeutic efficacy of NIBS in HAs were systematically screened and analyzed by two independent reviewers.The risk of bias in RCTs was assessed using the Cochrane’s Risk of Bias tool.A meta-analysis was conducted for qualified studies RCTs according to different forms of non-invasive brain stimulation.In addition,we recruited 8 patients with featured ataxia and confirmed by genetic testing as spinocerebellar ataxia(SCA)from the First hospital of China Medical University to assess the effects of r TMS.A total of 300 pluses targeting bilateral cerebellum were delivered in 20-second trains at 1Hz,with a 40-second intertrain interval per region and session for 10 consecutive days.The effects of r TMS were assessed by the difference of the total and subitem scores of ICARS before and after the treatment of r TMS.Results: In total,327 articles were identified,of which 18 articles(15 articles in English and 3 articles in Chinese)were fulfilled the inclusion criteria.There were two articles on transcranial direct current stimulation(t DCS)and one articles on intermittent θ burst stimulation(i TBS),respectively.15 articles were focused on TMS.We conducted a meta-analysis on 5 articles in which the SARA as the outcome variable to evaluate the effects of TMS.Meta-analysis indicated that a mean 1.77 decrease of the total score of SARA after r TMS(p=0.006).Subgroup analysis according the frequency showed that a mean 1.61 decrease of the total score of SARA after high frequency of r TMS(p=0.05),compared to no improvement effects after low frequency of r TMS(p=0.48).Three studies included the available ICARS scores to evaluate the effects of r TMS,a meta-analysis with fixed effects model showed that there was no statistically significant difference in pooled ICARS scores between r TMS group and sham group.(WMD=0.51,95%CI:-5.38 to 6.39;p=0.87).Two studies also described the changes post-intervention of BBS scores.The pooled outcome using a fixed effects model indicated no statistically significant difference between r TMS and sham group.(WMD=0.74,95%CI:-5.48 to 6.95;p=0.82).In our8 patients,the total score of ICARS(p=0.018)and the sub-score of posture and gait(p=0.016)and kinetic function(p=0.028)were decrease after the treatment of r TMS,and the differences were statistically significant.Conclusions: The results of this systematic review combined with our study showed that r TMS,as a common method of NIBS,can serve as a useful strategy to improve the clinical symptoms of patients with SCA,which is expected to be an effective treatment for the clinical symptoms of SCA. |
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