Efficacy of rTMS and TBS on the motor symptoms in Parkinson's disease: a network meta-analysis

The effects of theta-burst stimulation (TBS) and repetitive transcranial magnetic stimulation (rTMS) on the motor symptoms in Parkinson's disease (PD) were evaluated using a network meta-analysis (NMA).

Studies (1 January 2003-1 January 2025) from four databases were screened for analyses. A Bayesian NMA model was employed, and the surface under the cumulative ranking curve (SUCRA) was used to predict the efficacy ranking of each intervention. The study protocol was registered on the International Prospective Register of Systematic Reviews platform (Identification number: CRD42025646363).

A total of 28 randomized controlled trials were included. Subgroup analysis showed that multi-session cTBS was significantly superior to single-session cTBS in improving motor symptom. The main analysis (23 studies with multi-session protocols) revealed that, compared with sham stimulation, high-frequency (HF) rTMS-stimulating primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC) and cTBS-stimulating supplementary motor area (SMA) significantly improved global motor function, ranking first and second in SUCRA values, respectively. For specific symptoms, HF + SMA showed the best improvement in Freezing of Gait Questionnaire and time up and go test (SUCRA: 0.774 and 0.982, respectively), low-frequency stimulating SMA ranked first for improving bradykinesia (SUCRA = 0.944), and HF + M1 significantly improved quality of life. All interventions were well tolerated.

Multi-session TBS protocols are superior to single-session protocols. HF + M1 + DLPFC and cTBS + SMA represent the most promising protocols for improving global motor function in PD. For different motor symptoms, corresponding target-specific stimulation should be prioritized.