Efficacy and Safety of High-Frequency Repetitive Transcranial Magnetic Stimulation for Poststroke Depression: A Systematic Review and Meta-analysis

Objective: To summarize and systematically review the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (HFrTMS) for depression in patients with stroke. Data Sources: Six databases (Wanfang, the China National Knowledge Infrastructure, PubMed, Embase, Cochrane Library, and Web of Science) were searched from inception until November 15, 2018. Study Selection: Seventeen randomized controlled trials were included for meta-analysis. Data Extraction: Two independent reviewers selected potentially relevant studies based on the inclusion criteria, extracted data, and evaluated the methodological quality of the eligible trials using the Physiotherapy Evidence Database. Data Synthesis: We calculated the combined effect size (standardized mean difference [SMD] and odds ratio [OR]) for the corresponding effects models. Physiotherapy Evidence Database scores ranged from 7 to 8 points (mean =7.35). The study results indicated that HF-rTMS had significantly positive effects on depression in patients with stroke. The effect sizes of the SMD ranged from small to large (SMD,-1.01; 95% confidence interval [CI],-1.36 to-0.66; P<.001; I-2, 85%; n=1053), and the effect sizes of the OR were large (response rates, 58.43% vs 33.59%; OR, 3.31; 95% CI, 2.25-4.88; P<.001; I-2, 0%; n =529; remission rates, 26.59% vs 12.60%; OR, 2.72; 95% CI, 1.69-4.38; P<.001; I-2, 0%; n =529). In terms of treatment side effects, the HF-rTMS group was more prone to headache than the control group (OR, 3.53; 95% CI, 1.85-8.55; P<.001; f, 0%; n = 496). Conclusions: HF-rTMS is an effective intervention for poststroke depression, although treatment safety should be further verified via large sample multicenter trials. (C) 2019 by the American Congress of Rehabilitation Medicine