AUTHOR=Zhang Xiaoyun , Huai Yaping , Wei Zhiqiang , Yang Weiwei , Xie Qizhi , Yi Li 

TITLE=Non-invasive brain stimulation therapy on neurological symptoms in patients with multiple sclerosis: A network meta analysis

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1007702

DOI=10.3389/fneur.2022.1007702

ISSN=1664-2295

ABSTRACT=Objective: The aim of the study was to evaluate non-invasive brain stimulation (NIBS) (including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES)) on neurological symptoms in patients with multiple sclerosis (PwMS). 

Method: We searched PubMed, Embase, Cochrane Library, Web of Science and Ovid MEDLINE until Febrary 2022. And we evaluated the included studies for methodological quality by the Cochrane bias risk assessment tool. We perfomed network meta analysis (NMA) by using Stata 15 and ranked the results of the NMA by using the surface under the cumulative ranking curve (SUCRA) ranking chart. 

Result: 27 clinical trials were finally included (N=596, 66.4% women). For the immediate effects, rTMS over M1 yielded the most optimal scheme for fatigue reduction among all the interventions compared to the sham control groups [MD=-0.85, 95% CI (-1.57,-0.14)] (SUCRA=82.6%). iTBS over M1 yielded the most signifcant reduced pain level than the sham groups did [MD=-1.26, 95% CI (-2.40,-0.11)] (SUCRA=98.4%). tDCS over F3 was the best protocol of NIBS to improve quality of life (QOL) [MD=1.41, 95% CI =(0.45,2.36)] (SUCRA=76.7%), and iTBS over M1 may significantly reduce spasticity compared to sham stimulation [MD=-1.20, 95% CI =(-1.99,-0.41)] (SUCRA=90.3%). Furthermore, the use of rTMS, tRNS, and tDCS over certain areas may benefit pwMS accuracy, response time, manual dexterity, pain improvement, and improve QOL, but lack significant statistical differences.

Conclusion: Based on the NMA and SUCRA ranking, we can conclude that symptoms including fatigue, pain, spasticity, and QOL can be improved by following NIBS protocol after treatment as mentioned above, while tDCS over P4 may have a durable effect on mood problems for PwMS.