Zhongguo quanke yixue (Mar 2023)
Non-invasive Brain Stimulation Techniques Can Effectively Relieve Post-stroke Fatigue: a Meta-analysis
Abstract
Background Fatigue is one common symptom in stroke patients, which has been validated by studies to be negatively associated with the recovery of these patients. Non-invasive brain stimulation techniques can effectively promote or inhibit the excitability of cerebral cortex and accelerate neuroplasticity, but the efficacy and safety of the treatment for post-stroke fatigue are not clear. Objective To systematically evaluate the effects of non-invasive brain stimulation on post-stroke fatigue. Methods We searched randomized controlled trials (RCTs) of the efficacy of non-invasive brain stimulation techniques 〔transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) 〕 (experimental group) compared with that of regular rehabilitation training (control group) in post-stroke fatigue in PubMed, Web of Science, Embase and the Cochrane Library, CBM, CNKI, VIP, Wanfang Data and other databases from database inception to April 2022. The reported outcomes were assessed using the Fatigue Severity Scale (FSS) and Fugl-Meyer Assessment (FMA) scale. Two researchers conducted literature screening, data extraction and quality evaluation. RevMan 5.3 was used for meta-analysis. GRADE was used to evaluate the quality of the evidence for reported outcomes. Results A total of five RCTs with 331 subjects were included, among which three studied the efficacy of rTMS, and the other two studied the efficacy of tDCS. The methodological quality of all RCTs was categorized as grade B. Meta-analysis showed that the experimental group had lower mean FSS scores than the control group〔SMD=-2.13, 95%CI (-3.63, -0.63), P=0.005〕, and had higher FMA scores than the control group〔SMD=6.60, 95%CI (4.33, 8.87), P<0.000 01〕. Sensitivity analysis showed that the results were robust. Egger's test suggested that there was little potential publication bias in this meta-analysis (t=-0.88, P=0.445). The quality of reported evidence regarding three primary outcomes, namely, FSS scores after a 4-week and 8-week non-invasive brain stimulation, and FMA score after non-invasive brain stimulation, was rated as "low" by the GRADE system. Conclusion Non-invasive brain stimulation techniques have been proven by included RCTs to be effective in relieving fatigue symptoms, and promoting the recovery of motor functions in patients with post-stroke fatigue. However, due to small sample size and low quality of the evidence about reported outcomes after treatment, the conclusion needs to be further verified by high-quality, large-sample and multicenter RCTs.
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