摘要
目的系统评价重复经颅磁刺激(repeated Transcranial magnetic stimulation,rTMS)辅助治疗癫痫的效果。方法计算机检索PubMed、EMbase、Cochrane Library、中国生物医学文献服务系统、CNKI、维普和万方数据库,搜集关于rTMS治疗癫痫及相关疾病的随机对照试验(Randomized controlled trials,RCTs),检索时间均由建库截至2019年6月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏移风险后,采用RevMan5.3软件进行Meta分析。结果共纳入21篇RCTs,包括1 587例患者。Meta分析结果显示,rTMS辅助抗癫痫药物(AEDs)能提高癫痫治疗的有效率[RR=1.28,95%CI(1.19,1.37)],在癫痫合并焦虑抑郁患者的治疗上,无论高低频均能显著降低汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)及临床神经功能缺损程度评分(NFDS)评分[MD=-3.94,95%CI(-4.25,-3.63)]。而在辅助治疗脑瘫合并癫痫患儿方面,能提高患儿发育商(DQ)和粗大运动功能试验量表-88(GMFM-88)评分[MD=7.95,95%CI(7.00,8.90)]。此外,使用rTMS并不会引起额外的不良反应[peto OR=0.52,95%CI(0.31,0.84)]。结论当前证据显示,rTMS联合AEDs能提高药物治疗的有效率,在治疗癫痫并发的焦虑抑郁共病方面也能显著降低患者焦虑抑郁评分。此外,在辅助脑瘫合并癫痫患儿提高肌力及发育方面也有一定的作用,且rTMS并不会引起患者额外的不良反应。但由于受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。
Objective To systematically evaluate the effect of repeated transcranial magnetic stimulation(rTMS in treating epilepsy.Methods The randomized controlled trials(RCTs)of rTMS for epilepsy and related diseases were collected from PubMed,EMbase,Cochrane Library,CBM,CNKI,VIP,and Wanfang databases by computer.The retrieval time was from establishment to June 2019.Two researchers independently screened the literature,extracted the data and evaluated the deviation risks of the included studies.RevMan5.3 software was used for Meta analysis.Results A total of21 RCTs were included,including 1 587 patients.The results showed that rTMS assisted antiepileptics drugs(AEDs)could improve the effective rate of epilepsy treatment[RR=1.28,95%CI(1.19,1.37)],significantly reduced HAMA,HAMD and NFDS scores in the treatment of patients with epilepsy combined with anxiety and depression[MD=-3.94,95%CI(-4.25,-3.63)],and improve DQ and GMFM-88 scores in children with cerebral palsy combined with epilepsy(MD=7.95,95%CI(7.00,8.90))In addition,using rTMS will not cause additional adverse reaction[peto OR=0.52,95%CI(0.31,0.84)].Conclusions The current evidence showed that rTMS combined AEDs can improve the efficient of AEDs therapy.When treat anxiety depression comorbidity,it can significantly reduce the anxiety depression score.In addition in children with cerebral palsy merger,it can improve muscle strength and development.And rTMS will not cause additional adverse reactions.Limited by the quantity and quality of the selected studies,the conclusions need to be verified by more high-quality studies.
作者
童婧怡
黎昌炫
刘永宏
刘惠
马琳
李其富
TONG Jingyi;LI Changxuan;LIU Yonghong;LIU Hui;MA Lin;LI Qifu(Department of Neurology,second ward,the First Affiliated Hospital of Hainan Medical College,Haikou 570100,China;Department of Neurology,Leshan Geriatric Hospital,Leshan 614900,China)
出处
《癫痫杂志》
2019年第5期338-350,共13页
Journal of Epilepsy
基金
低频重复经颅磁刺激对难治性癫痫疗效的临床研究,HYFYPY201806
关键词
重复经颅磁刺激
癫痫
焦虑抑郁共病
脑瘫合并癫痫
癫痫辅助治疗
随机对照试验
repetitive Transcranial magnetic stimulation
Epilepsy
Anxiety depression comorbidity
Epilepsy with cerebral palsy merger
Adjuvant therapy
Randomized controlled trials
