Efficacy of repeated peripheral magnetic stimulation on upper limb motor function after stroke: a systematic review and meta-analysis of randomized controlled trials

 

 Didn't your competent? doctor start using this a decade ago? Oh, I guess you don't have a functioning stroke doctor or therapists, do you? Why haven't they been fired yet?

• rPMS (9 posts to December 2013)

Efficacy of repeated peripheral magnetic stimulation on upper limb motor function after stroke: a systematic review and meta-analysis of randomized controlled trials

Defu Liao¹Ziyan He¹Shichang Yan¹Qipei Ji¹Yuanlin Li¹Yuyuan Tu¹Zihao Zhou¹Shuangchun Ai^2*

• ¹School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
• ²Department of Rehabilitation, Mianyang Hospital of Traditional Chinese Medicine, Mianyang, China

Background: Post-stroke patients with upper motor neuron lesions have limited motor function in the upper limbs, and spasticity occurs in the limbs, thus affecting functional recovery and activities of daily living. Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive treatment often used in clinical rehabilitation. Recent studies have shown that it can reduce spasticity and improve motor function in patients.

Objective: This study aimed to evaluate the effectiveness of rPMS on upper limb motor function and spasticity in stroke patients by meta-analysis.

Materials and methods: Randomized controlled trials (RCTs) of rPMS in post-stroke patients were searched in PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials. Databases from the date of creation to 25 August 2024 were evaluated using the Cochrane Collaboration tool. Methodological quality was assessed using the Cochrane Collaboration tools, and meta-analyses were performed using RevMan (version 5.4) and Stata (version 14.0).

Results: A total of 8 studies were included. RPMS improved patients’ FMA-UE scores compared with controls (MD = 3.34, 95% CI = [0.53, 6.15], p = 0.02 < 0.05). RPMS also reduced spasticity (MD = −0.66, 95% CI = [−1.16, −0.15], p = 0.01 < 0.05) and increased patients’ ability to live independently (MD = 0.85, 95% CI = [0.19, 1.51], p = 0.01 < 0.05). Subgroup analyses showed that the efficacy of treatment frequency ≤ 20 Hz was better than that of frequency > 20 Hz; the treatment time using 15–20 min was more effective than using 30 min; and the application of round coil treatment was more effective than other types of coils.

Conclusion: The results suggest that if rPMS is used in post-stroke patients, their upper limb motor function and spasticity may improve.(NOT GOOD ENOUGH! Survivors want full recovery! Since this didn't do that it was a failure!) However, the number of studies is small, and further research is needed to extend the current analysis results.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, CRD42024584040.

1 Introduction

Stroke, being one of the more prevalent diseases globally, causes severe distress to patients and their families in terms of quality of life, finances, and man-hours. Globally, stroke is the second leading cause of death, accounting for 11.6% of all deaths (1). At the same time, the incidence of stroke is getting younger, which may be related to modern advanced neuroimaging or the dietary and work habits of young people (2). A range of complications can exist after stroke, including dysphagia, impaired consciousness, upper limb motor dysfunction, and cognitive dysfunction (3). If not treated effectively, upper limb motor dysfunction will seriously affect the patient’s daily life activities and cause inconvenience.

The treatment of upper limb motor dysfunction after stroke is based on adaptation or plasticity of the brain after the injury through the practice of specific tasks, medications, robotic trainers, and other methods of enhancing motor learning (4). Improvements in motor function can be achieved using Constraint Induced Movement Therapy (CIMT), which is an operant approach to progressively shape functionally more useful movements using a set of standardized tasks for reaching, grasping, and pinching (5) or by injecting Botulinum Toxin Type A (BoNT-A) to reduce spasticity in the patient’s limbs (6). In recent years, non-invasive stimulation (neuromuscular electrical stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation) has been applied to improve motor function after stroke (7, 8). However, we found that the use of repeated peripheral magnetic stimulation (rPMS) was rare due to unknown parameters and uncertainty about the stimulation site (9).

RPMS is the use of time-varying pulsed magnetic fields of a certain intensity to stimulate excitable tissues, thereby generating induced currents within the tissues, which pass through the nerve cell membranes and enter the axons, resulting in a change in cell membrane potential (10). When the intensity of the stimulus exceeds the cellular threshold, it causes the cell to depolarise to generate an action potential, which in turn causes the muscle to contract (11). Different parameters are applied to reduce pain or promote sensorimotor recovery (12, 13). Impairment of proprioceptive inputs may lead to slower recovery of motor function after stroke (14), one way to restore motor function in patients seems to be to enhance their proprioceptive stimulation. RPMS activates the remodeling of neural tissue in the brain by stimulating proprioceptive inputs, which in turn improves motor function (15). RPMS provides proprioceptive input to the CNS (central nervous system) in two different ways (16), one is direct activation: direct activation of sensorimotor nerve fibers through cis and transduction. The other is indirect activation: indirect activation through mechanoreceptors (class Ia, Ib, and II muscle fibers) during muscle contraction and relaxation. However, the preferential recruitment of cutaneous and proprioceptive afferents over nerves and muscles by rPMS remains controversial (9). There is evidence that the use of rPMS reduces spasticity on the affected side and increases sensory function on the hemiplegic side of the patient (17, 18). RPMS is a painless, non-invasive treatment that has negligible side effects. Suzuki et al. (19) applied rPMS to a male Wistar rat animal model and found that the use of rPMS may not produce damage to the muscles at the application site. Meanwhile, compared with conventional electrical stimulation, rPMS has the advantages of deeper depth and stronger stimulation force.

Although a meta-analysis by Momosaki et al. (20) showed improvement in upper limb spasticity in patients treated with rPMS, there was no statistically significant improvement in upper limb motor function in patients. This meta-analysis aimed to derive the feasibility of rPMS to improve upper limb motor function by analyzing the improvement of upper limb motor function in patients treated with rPMS as well as subgroup analyses at different frequencies, with different coil models, time of stimulation use, and length of post-stroke disease cycle, and to conclude on potentially appropriate therapeutic parameters.

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