The Therapeutic Effect of Transcranial Magnetic Stimulation on Post-stroke Aphasia and the Optimal Treatment Parameters: A Meta-analysis

The effect of theta burst stimulation (TBS) on aphasia in stroke patients: a protocol of systematic review and meta-analysis

BACKGROUND

Prior studies have 3suggested that theta burst stimulation (TBS) may be a promising intervention for the rehabilitation of aphasia after stroke. However, the results of these investigations have been inconsistent, with no definitive consensus on its efficacy and safety. Given the inconclusive nature of the existing evidence, this study aims to conduct a comprehensive and systematic review to evaluate the therapeutic effects of TBS on aphasia in stroke patients.

METHODS

We will perform an extensive search of eight online databases from their inception to August 1, 2024, to identify relevant randomized controlled trials (RCTs) that examine the impact of TBS on aphasia in stroke patients. The primary outcome will be the severity of aphasia, assessed using a suite of standardized evaluation tools. Secondary outcomes will include measures of naming, repetition, comprehension, spontaneous speech, aphasia quotient, quality of life, and documentation of adverse events. The review process will involve rigorous study selection, data extraction, risk of bias assessment, and evaluation of the certainty of evidence by two independent reviewers. Data synthesis and statistical analysis will be conducted using Review Manager (RevMan) software, version 5.3. If significant heterogeneity is not detected among the studies, a meta-analysis will be performed. Otherwise, a narrative qualitative summary will be provided. The quality of evidence will be assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system.

DISCUSSION

This study will be the first systematic review to comprehensively synthesize the existing evidence regarding the application of TBS in the treatment of aphasia in stroke patients. The findings are expected to provide valuable insights for clinicians and policymakers, facilitating the development of more equitable and high-quality healthcare services for this patient population.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42024521347.

Repetitive transcranial magnetic stimulation for post-stroke non-fluent aphasia: a systematic review and meta-analysis of randomized controlled trials

Objective

To systematically evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) on language function in patients with non-fluent aphasia post-stroke.

Methods

We selected randomized clinical trials (RCT) that involved stroke patients with non-fluent aphasia, whose intervention was rTMS vs. no therapy or other therapy. Two researchers autonomously reviewed the literature based on the specified criteria for inclusion and exclusion and completed the process of data extraction, data verification, and quality evaluation. Meta-analysis was performed using RevMan 5.4 and Stata MP 17, while the assessment of risk of bias was carried out utilizing the Risk of Bias version 2 tool (RoB2).

Results

The meta-analysis involved 47 RCTs, encompassing 2,190 patients overall. The indexes indicated that rTMS has the potential to decrease the severity of non-fluent aphasia in stroke patients, including improvement of the capability of repetition, naming, and spontaneous language. The determination of BDNF in the serum of patients was also increased. In addition, rTMS reduced the likelihood of depression in stroke patients.

Conclusion

To summarize the relevant studies, rTMS has significant effects on improving the language abilities of stroke patients suffering from non-fluent aphasia, including the abilities of repetition, naming, and spontaneous language.