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Review
. 2023 Sep 23;13(10):1362.
doi: 10.3390/brainsci13101362.

Behavioral Effects of Repetitive Transcranial Magnetic Stimulation in Disorders of Consciousness: A Systematic Review and Meta-Analysis

Zihan Yang  1 , Tian Yue  1 , Volker R Zschorlich  2 , Dai Li  3   4   5 , Duanwei Wang  6 , Fengxue Qi  7
Affiliations
Review

Behavioral Effects of Repetitive Transcranial Magnetic Stimulation in Disorders of Consciousness: A Systematic Review and Meta-Analysis

Zihan Yang et al. Brain Sci. .

Abstract

Traumatic brain injury, cardiac arrest, intracerebral hemorrhage, and ischemic stroke may cause disorders of consciousness (DoC). Repetitive transcranial magnetic stimulation (rTMS) has been used to promote the recovery of disorders of consciousness (DoC) patients. In this meta-analysis, we examined whether rTMS can relieve DoC patient symptoms. We searched through journal articles indexed in PubMed, the Web of Science, Embase, Scopus, and the Cochrane Library until 20 April 2023. We assessed whether studies used rTMS as an intervention and reported the pre- and post-rTMS coma recovery scale-revised (CRS-R) scores. A total of 207 patients from seven trials were included. rTMS significantly improved the recovery degree of patients; the weighted mean difference (WMD) of the change in the CRS-R score was 1.89 (95% confidence interval (CI): 1.39-2.39; p < 0.00001) in comparison with controls. The subgroup analysis showed a significant improvement in CRS-R scores in rTMS over the dorsolateral prefrontal cortex (WMD = 2.24; 95% CI: 1.55-2.92; p < 0.00001; I2 = 31%) and the primary motor cortex (WMD = 1.63; 95% CI: 0.69-2.57; p = 0.0007; I2 = 14%). Twenty-hertz rTMS significantly improved CRS-R scores in patients with DoC (WMD = 1.61; 95% CI: 0.39-2.83; p = 0.010; I2 = 31%). Furthermore, CRS-R scores in rTMS over 20 sessions significantly improved (WMD = 1.75; 95% CI: 0.95-2.55; p < 0.0001; I2 = 12%). rTMS improved the symptoms of DoC patients; however, the available evidence remains limited and inadequate.

Keywords: disorders of consciousness; recovery; repetitive transcranial magnetic stimulation.

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Conflict of interest statement

The authors assert that they have no conflicts of interest. Furthermore, the funders did not contribute to the study’s design, data collection, analysis, interpretation, manuscript writing, or the decision to publish the findings.

Figures

Figure 1
Figure 1
The flowchart of the search procedure. rTMS: repetitive transcranial magnetic stimulation; CRS-R: coma recovery scale-revised.
Figure 2
Figure 2
Risk of bias graph.
Figure 3
Figure 3
Meta−analysis of all protocols on the change in CRS-R score in patients with disorders of consciousness [24,25,26,27,28,30,31].
Figure 4
Figure 4
Meta-analysis of rTMS over the M1 and the DLPFC on the change in CRS-R score. M1: primary motor cortex; DLPFC: dorsolateral prefrontal cortex [24,25,26,28,30,31].
Figure 5
Figure 5
Meta-analysis of rTMS of 10 Hz and 20 Hz on the change in CRS-R score [24,25,27,28,30].
Figure 6
Figure 6
Meta-analysis of different stimulation duration on the change in CRS-R score [24,25,26,28].
See this image and copyright information in PMC

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