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Effect of non-invasive brain stimulation on conscious disorder in patients after brain injury: a network meta-analysis

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Abstract

Objective

To systematically evaluate the rehabilitation effect of non-invasive brain stimulation (NIBS) on disorder of consciousness (DOC) after brain injury and compare the effects of different NIBSs.

Methods

Randomized controlled trials (RCTs) on the effect of NIBS on DOC after brain injury were retrieved from the PubMed, Cochrane Library, Web of Science, CNKI, VIP, Wanfang Data, and CBM databases from inception to October 2022. The risk of bias and quality of the trials were assessed following the Cochrane Handbook of Systematic Reviews and the physiotherapy evidence database Jadad Scale. Statistical analysis was conducted with RevMan 5.4 and R Studio. This study was registered on PROSPERO (No. CRD42022371334).

Results

A total of 28 articles were included involving 1118 patients. Meta-analysis showed that NIBS combined with routine rehabilitation had the highest effect than the routine rehabilitation and the sham NIBS combined with routine rehabilitation. The cumulative probability ranking results showed that the rTMS was best. The order of network meta-analysis with GCS (Glasgow Coma Scale) as the outcome index is rTMS combined with routine rehabilitation > tDCS combined with routine rehabilitation > routine rehabilitation > NIBS sham stimulation combined with routine rehabilitation. The order of network meta-analysis with CRS-R (Coma Recovery Scale–Revised) as the outcome index is rTMS combined with routine rehabilitation > tDCS combined with routine rehabilitation > NIBS sham stimulation combined with routine rehabilitation > routine rehabilitation. For patients with different conditions of DOC, the subgroup analysis results showed that rTMS improved the effect of patients with severe DOC better than those with unclear conditions of DOC, but the overall results of the two groups were not significantly different. On the contrary, the effect of tDCS on patients with DOC whose condition was not clear was better than that on patients with severe DOC, and the effect on patients with severe DOC was not significant (P > 0.05). In terms of safety, only 9 articles mentioned ADRs in the included literature, including 8 articles without ADRs, and 1 article with ADRs.

Conclusion

Based on the research results of various indicators, NIBS can improve DOC after brain injury, and the rTMS is the best. Limited by the number and the quality of literature, the above conclusions need more high-quality research to verify.

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Data Availability

The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author.

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Authors and Affiliations

  1. College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China

    Yaning Li, Lingling Li & Hailiang Huang

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Contributions

Yaning Li: study conception and design, data acquisition, and analysis. Yaning Li, Lingling Li, Hailiang Huang: data interpretation, drafting and revising the manuscript. Hailiang Huang provided guidance regarding the methodology. All the authors contributed to the article and approved the submitted version.

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Correspondence to Hailiang Huang.

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Li, Y., Li, L. & Huang, H. Effect of non-invasive brain stimulation on conscious disorder in patients after brain injury: a network meta-analysis. Neurol Sci 44, 2311–2327 (2023). https://doi.org/10.1007/s10072-023-06743-7

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