Evaluating Repetitive Transcranial Magnetic Stimulation in Spinocerebellar Ataxia: A Meta-Analysis of Efficacy and...

To evaluate the efficacy and safety of repetitive Transcranial Magnetic Stimulation (rTMS) in Spinocerebellar Ataxia (SCA) patients. We conducted a systematic review and meta-analysis of nine Randomized Controlled Trials (RCTs). Searches covered major databases (Medline, Embase, CENTRAL, etc.) and trial registries (ICTRP, ClinicalTrials.gov). We included RCTs comparing rTMS with sham stimulation on outcomes for efficacy (ataxia severity, quality of life) and safety (adverse events, tolerability). Data were extracted, bias was assessed (RoB 2), and certainty of evidence was evaluated using the GRADE approach. All included studies used sham stimulation, with follow-ups up to four weeks. Pooled analyses showed significant differences favoring rTMS immediately post-intervention for global ataxia severity (International Cooperative Ataxia Rating Scale-ICARS-: MD -4.07, low certainty; Scale for the Assessment and Rating of Ataxia-SARA-: MD-1.55, very low certainty). Moderate-certainty evidence demonstrated significant improvements in the ICARS subdomains for posture and gait (MD -1.53, p<0.00001) and limb function (MD -3.59, p<0.00001). However, no significant effect was found for speech disorders. rTMS was well-tolerated; safety assessment showed no significant difference in adverse events or dropout rates (low certainty), and no serious adverse events were reported. Evidence was insufficient to assess the quality of life or long-term effects. Low to very-low certainty evidence suggests that rTMS, compared to sham, provides slight but clinically relevant short-term improvement in motor function and global ataxia severity in SCA patients, with comparable safety profiles. Our effect estimations are derived from small, highly heterogeneous RCTs conducted predominantly in Asian cohorts with SCA3. Rigorous studies with longer follow-up are needed to confirm the sustained utility of this intervention.