脳卒中患者の下肢運動機能改善のための非侵襲的脳刺激：系統的レビューおよびネットワークメタアナリシス

To explore and compare the effectiveness of various non-invasive brain stimulations (NiBS) on poststroke lower extremity disorders.

We searched for and gathered studies from Embase, PubMed, Web of Science, and Cochrane databases, with the most recent search carried out on 5 October 2024. All published studies meeting the eligibility criteria and investigating the effectiveness of NiBS in patients with poststroke lower limb disorders were included. A total of 29 studies involving 1,319 participants were reviewed. Two independent researchers extracted clinical characteristics and research data. Outcome measures included the Fugl-Meyer lower extremity scale, Barthel index, Berg balance scale (BBS), and timed up and go test. Standard pairwise meta-analysis results and treatment network geometry were generated using Stata MP version 15.0. Bayesian network analysis was conducted using R version 4.4.1 with the "BUGSnet" package.

The meta-analysis shows that low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and rTMS + transcranial direct current stimulation (tDCS) are effective neurostimulation therapies for enhancing poststroke lower limb motor function. Probability rankings indicate that, among all NiBS interventions examined, rTMS + tDCS may be the most effective. In terms of body balance, intermittent theta burst stimulation (iTBS) and LF-rTMS improved poststroke balance, with iTBS possibly being the most effective. For activities of daily living, iTBS, LF-rTMS, and rTMS + tDCS demonstrated beneficial effects, with LF-rTMS potentially being the most effective among them.