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Efficacy of rTMS combined with cognitive training in TBI with cognition disorder: a systematic review and meta-analysis

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Abstract

Post-traumatic brain injury cognitive disorder(PTBICD) is one of the common symptoms of TBI survivors, severely limiting their life and rehabilitation progress. Repetitive transcranial magnetic stimulation (rTMS) has been shown to modulate cognition in a non-invasive manner while there are inconsistencies in previous studies. A comprehensive systematic review of rTMS treatment in patients with PTBICD is warranted. To evaluate the efficacy and safety of rTMS + cognitive training(CT) in enhancing cognitive function among PTBICD patients. A comprehensive search was conducted in PubMed, EMBASE, Cochrane Library, WOS, CNKI, Wan Fang, VIP and CBM, to identify relevant randomized controlled trials(RCTs) published before December 20, 2023. The primary outcomes measured changes in global cognitive scales, while the secondary outcomes focused on improvements in attention, memory, event-related potentials, and activities of daily living. Meta-analysis of data was carried out using Stata 14.0. Fourteen studies including 820 PTBICD patients were included. The results showed that rTMS + CT significantly improved MoCA[WMD = 3.47, 95%CI (2.56, 4.38)], MMSE[WMD = 3.79, 95%CI (2.23, 5.35)], RBMT[WMD = 1.53, 95%CI (0.19, 2.87)], LOTCA[WMD = 5.68, 95%CI (3.11, 8.24)], and promoted MBI[WMD = 7.41, 95%CI (5.90, 8.92)] as well as reduced correlated potential P300 latency[WMD = -20.77, 95%CI (-38.08, -3.45)] and amplitude[WMD = 0.81, 95%CI (0.57, 1.06)] in PTBICD compared to sham rTMS or CT, while adverse reaction ratio was higher than that of control group [RR = 1.67, 95%CI (1.00, 2.77)]. The results demonstrated that rTMS + CT can improve the cognitive function, mental state and daily activity ability of PTBICD patients. Systematic Review Registration: [PROSPERO], identifier [No. CRD42024520596].

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Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This review is supported by Administration of Traditional Chinese Medicine of Sichuan Province (Project No. 2020lc0080) and Science and Technology Development Fund of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (Project No. 22ZL10).

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  1. Jia Chen, Yuanwei Dong, and Hong Guo have contributed equally to this work and share first authorship.

Authors and Affiliations

  1. School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China

    Jia Chen

  2. Orthopedics Department, Hospital of Chengdu University of Traditional Chinese Medicine, No.39, 12 Bridge Road, Jinniu District, Chengdu, 610000, Sichuan, China

    Yuanwei Dong

  3. Rehabilitation Department, Hospital of Chengdu University of Traditional Chinese Medicine, No.39, 12 Bridge Road, Jinniu District, Chengdu, 610000, Sichuan, China

    Hong Guo, Tianyu Zhao, Di Zhang & Song Jin

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Contributions

J.C.made the biggest contribution for one to this study. J.C., Y.W.D., H.G., T.Y.Z., S.J. and D.Z. were responsible for conception and design and for the search procedure and check. J.C., H.G. and T.Y.Z. were responsible for extracting data and quality assessment. In addition, J.C., Y.W.D. and S.J. made great contributions in developing the retrieval strategy, PEDro grading, revising discussion section. All authors made substantial contributions to conception and design and interpretation of the data, drafted the manuscript and gave final approval of the final version. D.Z. is responsible for the overall content. All authors read and approved the final manuscript.

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Correspondence to Yuanwei Dong, Tianyu Zhao, Di Zhang or Song Jin.

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Chen, J., Dong, Y., Guo, H. et al. Efficacy of rTMS combined with cognitive training in TBI with cognition disorder: a systematic review and meta-analysis. Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07530-8

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