Basic Investigative Studies: Meta-Analysis

Emadi A.a,b· Halakoo S.c· Delkhoush C.T.c· Ehsani F.c

Author affiliations

aFood Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iran
bDeputy of Research and Technology, Semnan University of Medical Sciences, Semnan, Iran
cNeuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran

Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Access via DeepDyve Unlimited fulltext viewing of this article Organize, annotate And mark up articles Printing And downloading restrictions apply

Select

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview

Received: July 03, 2021
Accepted: November 07, 2022
Published online: January 05, 2023

Number of Print Pages: 11
Number of Figures: 3
Number of Tables: 4

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: https://www.karger.com/ENE

Abstract

Introduction: Multiple sclerosis (MS) is a common neurological disorder in societies. The most common symptoms in patients with MS are gait disorders and spasticity. Pharmacological therapies have mild therapeutic influence with more side effects for management of these symptoms. There is evidence that neuro-rehabilitation techniques have more appropriate effects rather than pharmacological therapies. In this regard, some studies indicated the beneficial effects of brain stimulation techniques on gait improvement and decreasing spasticity in patients with MS, while the others have not shown any efficacy. Accordingly, conducting a meta-analysis study in this issue is very important. Methods: A systematic search was performed in PubMed, Scopus, and ISI Web of Science from database inception on December 6, 2020, to find interventional studies assessing the effects of neuromodulators (transcranial direct-current stimulation [tDCS] or transcranial magnetic stimulation [TMS]) on spasticity, balance, and gait in patients with MS. The included studies were qualitatively assessed by the Physiotherapy Evidence Database (PEDro) scale. Finally, the homogeneity studies were analyzed by Stata software. Study-specific results were pooled by using a random-effects model. Results: A total of seven studies were included in the analysis. In the pooled analysis of studies, a significant effect of the TMS technique on spasticity was observed in patients with MS: −0.80 (95% CI: −1.31, −0.29). In addition, no significant effect of the single-session tDCS technique on gait speed was observed in patients with MS: 0.11 (95% CI: −0.11, 0.32). Conclusions: One of the main causes of discrepancy in the findings of included studies is the number of sessions for using neuromodulator techniques. A single session of anodal tDCS is not enough to improve gait in patients with MS. In addition, meta-analysis shows that multi-session TMS is effective intervention for decreasing spasticity in patients with MS.

© 2023 S. Karger AG, Basel

References Sadovnick AD, Ebers G. Epidemiology of multiple sclerosis: a critical overview. Can J Neurol Sci. 1993;20(1):17–29. Naci H, Fleurence R, Birt J, Duhig A. Economic burden of multiple sclerosis. Pharmacoeconomics. 2010;28(5):363–79. Oreja-Guevara C, González-Segura D, Vila C. Spasticity in multiple sclerosis: results of a patient survey. Int J Neurosci. 2013;123(6):400–8. Frohman EM, Racke MK, Raine CS. Multiple sclerosis—the plaque and its pathogenesis. N Engl J Med. 2006;354(9):942–55. Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sørensen PS, Thompson AJ, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83(3):278–86. Fjeldstad C, Pardo G, Bemben D, Bemben M. Decreased postural balance in multiple sclerosis patients with low disability. Int J Rehabil Res. 2011;34(1):53–8. Lance JW. Symposium synopsis In: Spasticity: disordered motor control; 1980. p. 487–9. Oveisgharan S, Karimi Z, Abdi S, Sikaroodi H. The use of brain stimulation in the rehabilitation of walking disability in patients with multiple sclerosis: a randomized double-blind clinical trial study. Iran J Neurol. 2019;18(2):57–63. Iodice R, Manganelli F, Dubbioso R. The therapeutic use of non-invasive brain stimulation in multiple sclerosis–a review. Restorative Neurol Neurosci. 2017;35(5):497–509. Workman CD, Kamholz J, Rudroff T. Transcranial direct current stimulation (tDCS) to improve gait in multiple sclerosis: a timing window comparison. Front Hum Neurosci. 2019;13:420. Dunn J, Blight A. Dalfampridine: a brief review of its mechanism of action and efficacy as a treatment to improve walking in patients with multiple sclerosis. Curr Med Res Opin. 2011;27(7):1415–23. Mori F, Koch G, Foti C, Bernardi G, Centonze D. The use of repetitive transcranial magnetic stimulation (rTMS) for the treatment of spasticity. Prog Brain Res. 2009;175:429–39. Palm U, Ayache SS, Padberg F, Lefaucheur J-P. Non-invasive brain stimulation therapy in multiple sclerosis: a review of tDCS, rTMS and ECT results. Brain stimulation. 2014;7(6):849–54. Hummel F, Celnik P, Giraux P, Floel A, Wu W-H, Gerloff C. Effects of non-invasive cortical stimulation on skilled motor function in chronic stroke. Brain. 2005;128(3):490–9. Hummel FC, Voller B, Celnik P, Floel A, Giraux P, Gerloff C, et al. Effects of brain polarization on reaction times and pinch force in chronic stroke. BMC Neurosci. 2006;7(1):73–10. Tanaka S, Takeda K, Otaka Y, Kita K, Osu R, Honda M, et al. Single session of transcranial direct current stimulation transiently increases knee extensor force in patients with hemiparetic stroke. Neurorehabil Neural Repair. 2011;25(6):565–9. Fregni F, Boggio PS, Santos MC, Lima M, Vieira AL, Rigonatti SP, et al. Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease. Mov Disord. 2006;21(10):1693–702. Mori F, Codecà C, Kusayanagi H, Monteleone F, Boffa L, Rimano A, et al. Effects of intermittent theta burst stimulation on spasticity in patients with multiple sclerosis. Eur J Neurol. 2010;17(2):295–300. Centonze D, Koch G, Versace V, Mori F, Rossi S, Brusa L, et al. Repetitive transcranial magnetic stimulation of the motor cortex ameliorates spasticity in multiple sclerosis. Neurology. 2007;68(13):1045–50. Korzhova J, Bakulin I, Sinitsyn D, Poydasheva A, Suponeva N, Zakharova M, et al. High-frequency repetitive transcranial magnetic stimulation and intermittent theta-burst stimulation for spasticity management in secondary progressive multiple sclerosis. Eur J Neurol. 2019;26(4):680–e44. Mori F, Ljoka C, Magni E, Codecà C, Kusayanagi H, Monteleone F, et al. Transcranial magnetic stimulation primes the effects of exercise therapy in multiple sclerosis. J Neurol. 2011;258(7):1281–7. Pilloni G, Choi C, Coghe G, Cocco E, Krupp LB, Pau M, et al. Gait and functional mobility in multiple sclerosis: immediate effects of transcranial direct current stimulation (tDCS) paired with aerobic exercise. Front Neurol. 2020;11:310. Iodice R, Dubbioso R, Ruggiero L, Santoro L, Manganelli F. Anodal transcranial direct current stimulation of motor cortex does not ameliorate spasticity in multiple sclerosis. Restorative Neurol Neurosci. 2015;33(4):487–92. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1–e34. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statist Med. 2002;21(11):1539–58. Higgins J. Cochrane handbook for systematic reviews of interventionsThe Cochrane Collaboration; 2011. Available from: www.cochrane-handbook.org. Şan AU, Yılmaz B, Kesikburun S. The effect of repetitive transcranial magnetic stimulation on spasticity in patients with multiple sclerosis. J Clin Neurol. 2019;15(4):461–7. Pilloni G, Choi C, Shaw MT, Coghe G, Krupp L, Moffat M, et al. Walking in multiple sclerosis improves with tDCS: a randomized, double-blind, sham-controlled study. Ann Clin Transl Neurol. 2020;7(11):2310–9. Tyler ME, Kaczmarek KA, Rust KL, Subbotin AM, Skinner KL, Danilov YP. Non-invasive neuromodulation to improve gait in chronic multiple sclerosis: a randomized double blind controlled pilot trial. J Neuroengineering Rehabil. 2014;11(1):79. Pilloni G, Choi C, Shaw MT, Coghe G, Krupp L, Moffat M, et al. Walking in multiple sclerosis improves with tDCS: a randomized, double-blind, sham-controlled study. Ann Clin Transl Neurol. 2020;7(11):2310–9. Barros Galvão SC, Borba Costa dos Santos R, Borba dos Santos P, Cabral ME, Monte-Silva K. Efficacy of coupling repetitive transcranial magnetic stimulation and physical therapy to reduce upper-limb spasticity in patients with stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2014;95(2):222–9. Nielsen JF, Sinkjaer T, Jakobsen J. Treatment of spasticity with repetitive magnetic stimulation; a double-blind placebo-controlled study. Mult Scler. 1996;2(5):227–32. Perez MA, Lungholt BKS, Nielsen JB. Short-term adaptations in spinal cord circuits evoked by repetitive transcranial magnetic stimulation: possible underlying mechanisms. Exp Brain Res. 2005;162(2):202–12. Meunier S, Pierrot-Deseilligny E. Cortical control of presynaptic inhibition of Ia afferents in humans. Exp Brain Res. 1998;119(4):415–26. Fregni F, Pascual-Leone A. Technology insight: noninvasive brain stimulation in neurology—perspectives on the therapeutic potential of rTMS and tDCS. Nat Rev Neurol. 2007;3(7):383–93. Meesen RL, Thijs H, Leenus DJ, Cuypers K. A single session of 1 mA anodal tDCS-supported motor training does not improve motor performance in patients with multiple sclerosis. Restorative Neurol Neurosci. 2014;32(2):293–300. Thickbroom GW, Byrnes ML, Archer SA, Kermode AG, Mastaglia FL. Corticomotor organisation and motor function in multiple sclerosis. J Neurol. 2005;252(7):765–71. Kale N, Agaoglu J, Onder G, Tanik O. Correlation between disability and transcranial magnetic stimulation abnormalities in patients with multiple sclerosis. J Clin Neurosci. 2009;16(11):1439–42. Article / Publication Details

First-Page Preview

Received: July 03, 2021
Accepted: November 07, 2022
Published online: January 05, 2023

Number of Print Pages: 11
Number of Figures: 3
Number of Tables: 4

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: https://www.karger.com/ENE

Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.