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. 2023 Jan 10:14:1065126.
doi: 10.3389/fnagi.2022.1065126. eCollection 2022.

Effects of non-invasive brain stimulation on walking and balance ability in Parkinson's patients: A systematic review and meta-analysis

Xinxin Zhang  1 , Feiyue Jing  1 , Yu'ang Liu  1 , Jinyong Tang  1 , Xianfeng Hua  1 , Jialin Zhu  1 , Haowen Tuo  1 , Qihan Lin  1 , Pincao Gao  1 , Weiguo Liu  1
Affiliations

Effects of non-invasive brain stimulation on walking and balance ability in Parkinson's patients: A systematic review and meta-analysis

Xinxin Zhang et al. Front Aging Neurosci. .

Abstract

Objective: To investigate and contrast the effects of non-invasive brain stimulation (NIBS), including repeated transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), on walking and balance ability in patients with Parkinson's disease (PD).

Methods: The PubMed, Embase, Medline, Cochrane, CNKI, and Chinese WanFang databases were searched up to June 2022. Quality assessment was performed using the Cochrane Collaboration's risk-of-bias guidelines, and the standardized mean differences (SMD) or mean differences (MD) for each outcome were calculated.

Results: Among 32 eligible studies, including 1,586 participants were analyzed in this meta-analysis. The results of the meta-analysis showed that NIBS was effective in improving UPDRS-III scores (MD = -2.07; 95% CI, -2.62 to -1.53; P < 0.00001; I 2 = 6%) and variables associated with the ability of walk such as step width (SMD = 0.35; 95% CI, 0.16-0.55; P = 0.0005; I 2 = 38%), cadence (SMD = 0.3; 95% CI, 0.05 to 0.55; P = 0.02; I 2 = 25%), and 6MWT (MD = 62.86; 95% CI, 39.43-86.29; P < 0.00001; I 2 = 0%). In subgroup analyses across intervention types, UPDRS-III scores (rTMS: MD = -2.54; 95% CI, -3.16 to -1.92; P < 0.00001; I 2 = 0%; tDCS: MD = -1.20; 95% CI, -1.99 to -0.40; P = 0.003; I 2 = 0%) and TUGT time (rTMS: MD = -4.11; 95% CI, -4.74 to -3.47; P < 0.00001; I 2 = 0%; tDCS: MD = -0.84; 95% CI, -1.48 to -0.21; P = 0.009; I 2 = 0%) significantly improved. Moreover, our results also showed that compared to tDCS, rTMS was more significant in improving UPDRS-III scores and TUGT time (p < 0.05).

Conclusion: NIBS benefits some walking ability variables but not balance ability in 36 patients with PD. The rTMS significantly improved UPDRS-III scores and TUGT time compared to tDCS. Further studies are needed to determine the optimal protocol and to illuminate effects based on the ideal target brain regions, stimulation intensity, timing, and type of intervention.

Systematic review registration: http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022350782.

Keywords: Parkinson’s disease; meta-analysis; non-invasive brain stimulation; repetitive transcranial magnetic stimulation; transcranial direct current stimulation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The flow diagram of the selection process.
FIGURE 2
FIGURE 2
Risk of bias summary.
FIGURE 3
FIGURE 3
Meta-analyses of the effect of NIBS on UPDRS-III scores compared with the control group.
FIGURE 4
FIGURE 4
Meta-analyses of the effect of NIBS on balance compared with the control group.
FIGURE 5
FIGURE 5
Meta-analyses of the effect of NIBS on TUGT time compared with the control group.
FIGURE 6
FIGURE 6
Meta-analyses of the effect of NIBS on 6MWD compared with the control group.
FIGURE 7
FIGURE 7
Meta-analyses of the effect of NIBS on other walking parameters compared with the control group.
FIGURE 8
FIGURE 8
Funnel plot for UPDRS-III scores.
FIGURE 9
FIGURE 9
Egger’s publication bias plot for UPDRS-III scores.
FIGURE 10
FIGURE 10
Funnel plot for gait speed.
FIGURE 11
FIGURE 11
Egger’s publication bias plot for gait speed.
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