Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jan 3;29(1):18.
doi: 10.1186/s40001-023-01525-5.

A literature review and meta-analysis of the optimal factors study of repetitive transcranial magnetic stimulation in post-infarction aphasia

Yang Tan #  1 , Lin-Ming Zhang #  2 , Xing-Ling Liang #  1 , Guei-Fei Xiong  1 , Xuan-Lin Xing  1 , Qiu-Juan Zhang  1 , Bing-Ran Zhang  1 , Zi-Bin Yang  3   4 , Ming-Wei Liu  5   6
Affiliations
Review

A literature review and meta-analysis of the optimal factors study of repetitive transcranial magnetic stimulation in post-infarction aphasia

Yang Tan et al. Eur J Med Res. .

Abstract

Background: The existing literature indicates that repetitive transcranial magnetic stimulation (rTMS) can potentially enhance the prognosis of poststroke aphasia (PSA). Nevertheless, these investigations did not identify the most effective parameters or settings for achieving optimal treatment outcomes. This study involved a meta-analysis aimed to identify the optimal variables for rTMS in treating post-infarction aphasia to guide the use of rTMS in rehabilitating PSA.

Methods: PubMed, Embase, and Cochrane Library databases were searched from inception to May 2023, and articles were reviewed manually using subject words and free words and supplemented with references from the included literature to obtain additional relevant literature. The search terms included "poststroke aphasia" and "repetitive transcranial magnetic stimulation (rTMS)" repetitive transcranial magnetic stimulation. Additionally, a review of the reference lists of previously published systematic reviews identified through the Cochrane Database of Systematic Reviews (search terms: poststroke aphasia, rTMS; restrictions: none) and PubMed (search terms: poststroke aphasia, rTMSs; restrictions: systematic review or meta-analysis) was performed. Information from studies involving different doses of rTMS in PSA was independently screened and extracted by 2 researchers.

Results: This meta-analysis included 387 participants with PSA across 18 randomized controlled trials. The results showed that the total pulse had a trend toward a significant correlation with the treatment effect (P = 0.088), while all other variables did not correlate significantly. When rTMS was not grouped by stimulus parameter and location, our nonlinear results showed that when the total pulses were 40,000 (standardized mean difference (SMD):1.86, 95% credible interval (CrI) 0.50 to 3.33), the pulse/session was 1000 (SMD:1.05, 95% CrI 0.55-1.57), and an RMT of 80% (SMD:1.08, 95% CrI 0.60-1.57) had the best treatment effect. When rTMS was grouped by stimulus parameters and location, our nonlinear results showed that when the total low-frequency (LF)-rTMS-right inferior frontal gyrus (RIFG) pulse was 40,000 (SMD:1.76, 95% CrI:0.36-3.29), the pulse/session was 1000 (SMD:1.06, 95% CrI:0.54-1.59). Optimal results were obtained with an RMT of 80% (SMD:1.14, 95% CrI 0.54 - 1.76).

Conclusions: The optimal treatment effects of rTMS for PSA may be obtained with a total pulse of 40,000, a pulse/session of 1000, and an RMT of 80%. Further rigorous randomized controlled studies are required to substantiate the validity of these results.

Keywords: Aphasia; Cerebral infarction; Optimal dose; Repetitive transcranial magnetic stimulation; Treatment.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Process of literature screening
Fig. 2
Fig. 2
Nonlinear analysis of the effects of different total pulses (A), pulses/sessions (B), and RMT (C) in patients with poststroke aphasia treated with rTMS when rTMS is not grouped by stimulation parameter and location
Fig. 3
Fig. 3
Nonlinear analysis of the effects of different total pulses (A), pulses/sessions (B), and RMT (C) in patients with poststroke aphasia treated with rTMS when rTMS is grouped by stimulation parameter and location
See this image and copyright information in PMC

References

    1. Sheppard SM, Sebastian R. Diagnosing and managing post-stroke aphasia. Expert Rev Neurother. 2021;21(2):221–234. doi: 10.1080/14737175.2020.1855976. - DOI - PMC - PubMed
    1. Ehsaan F, Mumtaz N, Saqulain G. Novel therapeutic techniques for post stroke aphasia: a narrative review. J Pak Med Assoc. 2022;72(1):121–125. doi: 10.47391/JPMA.2277. - DOI - PubMed
    1. Wu S, Wu B, Liu M, Chen Z, Wang W, Anderson CS, Sandercock P, Wang Y, Huang Y, Cui L, Pu C, Jia J, Zhang T, Liu X, Zhang S, Xie P, Fan D, Ji X, Wong KL, Wang L. Stroke in China: advances and challenges in epidemiology, prevention, and management. Chinastroke study collaboration. Lancet Neurol. 2019;18(4):394–405. doi: 10.1016/S1474-4422(18)30500-3. - DOI - PubMed
    1. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. American heart association council on epidemiology and prevention statistics committee and stroke statistics subcommittee. Heart disease and stroke statistics-2020 update: a report from the American heart Association. Circulation. 2020;141(9):e139–e596. doi: 10.1161/CIR.0000000000000757. - DOI - PubMed
    1. Beuter A, Balossier A, Vassal F, Hemm S, Volpert V. Cortical stimulation in aphasia following ischemic stroke: toward model-guided electrical neuromodulation. Biol Cybern. 2020;114(1):5–21. doi: 10.1007/s00422-020-00818-w. - DOI - PubMed