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. 2024 May 16:15:1360437.
doi: 10.3389/fneur.2024.1360437. eCollection 2024.

Acupuncture combined with repetitive transcranial magnetic stimulation for the treatment of post-stroke depression: a systematic evaluation and meta-analysis based on a randomised controlled trial

Keyuan Xiao  1 , Xiang Li  1 , Wenqing Hu  1 , Xinghua Li  1
Affiliations

Acupuncture combined with repetitive transcranial magnetic stimulation for the treatment of post-stroke depression: a systematic evaluation and meta-analysis based on a randomised controlled trial

Keyuan Xiao et al. Front Neurol. .

Abstract

Objective: This study aimed to systematically assess the efficacy of combining acupuncture with repetitive transcranial magnetic stimulation (rTMS) in treating post-stroke depression (PSD).

Methods: We conducted a comprehensive search of eight major domestic and international databases, including the China Knowledge Network, from inception until December 2023. Included were randomized controlled trials that investigated acupuncture combined with rTMS for PSD. The screening process adhered to predetermined inclusion and exclusion criteria, and study quality was assessed using Cochrane Handbook 5.1 guidelines. Meta-analysis was conducted using RevMan 5.4 software.

Results: Twelve studies involving 800 patients were included in the analysis. The meta-analysis showed that acupuncture combined with rTMS significantly improved the clinical effectiveness rate (RR = 1.19, 95% CI: 1.12 to 1.27, p < 0.00001) and reduced scores on several scales: Hamilton Depression Scale (HAMD) (MD = -3.35, 95% CI: -3.79 to -2.90, p < 0.00001), Self-Depression Scale (SDS) (MD = -9.57, 95% CI: -12.26 to -6.89, p < 0.00001), Chinese Medicine Symptom Score (MD = -3.34, 95% CI: -3.76 to -2.91, p < 0.00001), Pittsburgh Sleep Quality Scale (MD = -3.91, 95% CI: -4.58 to -3.25, p < 0.00001), and National Institutes of Health Stroke Scale (NIHSS) (MD = -2.77, 95% CI: -3.21 to -2.32, p < 0.00001). Furthermore, acupuncture combined with rTMS treatment improved cognitive functioning (MMSE, MoCA scores) (p < 0.00001) and ability to perform activities of daily living scores (MD = 10.40, 95% CI: 9.53 to 11.28, p < 0.00001). Additionally, it was found to reduce interleukin 6, tumor necrosis factor alpha, interleukin 1β, and increase 5-hydroxytryptamine and brain-derived neurotrophic factor levels (p < 0.001).

Conclusion: Acupuncture combined with rTMS therapy is recommended for treating PSD, as it effectively improves clinical outcomes, alleviates depressive symptoms, enhances cognitive function, and daily living capabilities, and modulates inflammatory responses and neurotransmitter levels. However, it is important to note that the limitations of the sample size and quality of the included studies warrant the need for more high-quality research to validate these conclusions.

Systematic review registration: INPLASY, Identifier INPLASY202430085.

Keywords: acupuncture; meta-analysis; post-stroke depression; repetitive transcranial magnetic stimulation; systematic review.

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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
Literature screening process for acupuncture combined with rTMS in the treatment of PSD.
Figure 2
Figure 2
Acupuncture combined with rTMS for the treatment of depressive states after stroke proportion of risk of bias for inclusion in the literature.
Figure 3
Figure 3
Acupuncture combined with rTMS for the treatment of depressive states after stroke a methodological quality assessment of the included literature.
Figure 4
Figure 4
Meta-analysis of the effectiveness of acupuncture combined with rTMS in the treatment of PSD.
Figure 5
Figure 5
Meta-analysis of HAMD scores in acupuncture combined with rTMS for PSD.
Figure 6
Figure 6
Meta-analysis of SDS scores in acupuncture combined with rTMS for PSD.
Figure 7
Figure 7
Meta-analysis of Chinese medicine symptom scores in acupuncture combined with rTMS for PSD.
Figure 8
Figure 8
Meta-analysis of PSQI scores in acupuncture combined with rTMS for PSD.
Figure 9
Figure 9
Meta-analysis of NIHSS scores in acupuncture combined with rTMS for PSD.
Figure 10
Figure 10
Meta-analysis of cognitive function in acupuncture combined with repetitive transcranial magnetic stimulation for PSD.
Figure 11
Figure 11
Meta-analysis of inflammatory factors in PSD after acupuncture combined with repetitive transcranial magnetic stimulation in WisdomLink stroke.
Figure 12
Figure 12
Neurotransmitter meta-analysis of depression after acupuncture combined with repetitive transcranial magnetic stimulation in wise link stroke.
Figure 13
Figure 13
Funnel plot of clinical effectiveness of acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of PSD.
Figure 14
Figure 14
The efficient Eggers test.
See this image and copyright information in PMC

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