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Efficacy of intermittent theta burst stimulation (iTBS) on post-stroke cognitive impairment (PSCI): a systematic review and meta-analysis

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Abstract

Background

Stroke is a significant global cause of mortality and morbidity, and post-stroke cognitive impairment (PSCI) affects up to half of stroke patients. Despite the availability of pharmacological and non-pharmacological interventions, there is a lack of definitive effective treatments for PSCI. Non-invasive brain stimulation, particularly intermittent theta burst stimulation (iTBS), has emerged as a promising therapy for the treatment of PSCI.

Objective

This systematic review and meta-analysis aimed to evaluate the efficacy and safety of iTBS in enhancing cognitive function among patients with PSCI.

Methods

A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, Scopus, Cochrane Library, and CNKI, to identify relevant randomized controlled trials published before April 2023. The primary outcome measured changes in global cognitive scales, while the secondary outcomes focused on improvements in attention, orientation, visual-spatial perception, and activities of daily living.

Results

The meta-analysis encompassed six studies involving 325 patients. The results demonstrated that iTBS led to a significant improvement in global cognitive scales (SMD = 1.12, 95% CI = [0.59 to 1.65], P < 0.0001), attention (SMD = 0.48, 95% CI [0.13 to 0.82], P = 0.007), visual perception (SMD = 0.99, 95% CI [0.13 to 1.86], P = 0.02), and activities of daily living (SMD = 0.82, 95% CI [0.55 to 1.08], P < 0.00001). However, there was no significant effect on orientation (SMD = 0.36, 95% CI [− 0.04 to 0.76], P = 0.07). Subgroup analysis based on the number of sessions was conducted, revealing a significant improvement in global cognition among patients with PSCI across the three categories (10 sessions, 20 sessions, and 30 sessions) with no between-group difference (P = 0.28). None of the included studies reported any serious adverse effects.

Conclusion

In conclusion, iTBS appears to be a safe and effective non-invasive treatment that can enhance the cognitive abilities and daily living skills of patients with post-stroke cognitive impairment. However, our conclusion is constrained by the limited number of studies. Further high-quality, large-sample RCTs with extended follow-up periods are necessary to validate these findings. Integrating iTBS with brain imaging techniques, such as functional near-infrared spectroscopy and functional magnetic resonance, could aid in understanding the mechanism of iTBS action.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request. Guarantor: Moaz Elsayed.

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Acknowledgements

The authors would like to thank Dr. Rehab Adel Diab and Dr. Ahmed Negida for providing support and advice as well as helping with the revision of this paper.

Author information

Author notes

  1. Asma Daoud and Moaz Elsayed contributed equally and share first authorship.

  2. Maickel AbdelMeseh and Taleb Alsalloum contributed equally.

Authors and Affiliations

  1. Medical Research Group of Egypt (MRGE), Cairo, Egypt

    Asma Daoud, Moaz Elsayed, Asmaa Zakria Alnajjar, Abdulrahman Krayim, Maickel AbdelMeseh, Taleb Alsalloum, Yehia Nabil & Roaa Faisal

  2. Faculty of Medicine, Ferhat Abbas University, Setif, Algeria

    Asma Daoud

  3. Faculty of Medicine, Cairo University, Cairo, Egypt

    Moaz Elsayed

  4. Faculty of Medicine, Al- Al-Azhar University, Gaza, Palestine

    Asmaa Zakria Alnajjar

  5. Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Abdulrahman Krayim

  6. Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Maickel AbdelMeseh

  7. Faculty of Medicine, University of Hama, Hama, Syria

    Taleb Alsalloum

  8. Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Yehia Nabil

  9. School of Medicine, Ahfad University for Women, Omdurman, Sudan

    Roaa Faisal

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Contributions

• Study conceptualization and design: Asmaa Daoud, Moaz Elsayed.

• Protocol design: all authors

• Abstract screening on Rayyan, full-text screening and study selection, data extraction, and quality assessment: all authors

• Data analysis: Asma Daoud, Moaz Elsayed

• Writing: all authors contributed in the following order: Moaz Elsayed, Asmaa Daoud, Asmaa Zakria Alnajjar, Abdulrahman Krayim, Maickel AbdelMeseh, Taleb Alsalloum, Yehia Nabil, Roaa Faisal

• Figures and tables: Asmaa Zakria Alnajjar, Abdulrahman Krayim

• Proofreading and revision: Moaz Elsayed, Rehab Diab, Ahmed Negida

Corresponding author

Correspondence to Moaz Elsayed.

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Informed consent and Ethical approval were not sought for this paper because it included no direct interaction with human participants.

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Daoud, A., Elsayed, M., Alnajjar, A.Z. et al. Efficacy of intermittent theta burst stimulation (iTBS) on post-stroke cognitive impairment (PSCI): a systematic review and meta-analysis. Neurol Sci 45, 2107–2118 (2024). https://doi.org/10.1007/s10072-023-07267-w

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