AUTHOR=Dong Ke , Zhu Xiaoxia , Xiao Wenwu , Gan Chu , Luo Yulu , Jiang Manying , Liu Hanjun , Chen Xi 

TITLE=Comparative efficacy of transcranial magnetic stimulation on different targets in Parkinson’s disease: A Bayesian network meta-analysis

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=Volume 14 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2022.1073310

DOI=10.3389/fnagi.2022.1073310

ISSN=1663-4365

ABSTRACT=Background/Objective
  The efficacy of transcranial magnetic stimulation (TMS) on Parkinson’s disease (PD) varies with parameters. This study aims to estimate the effect of different TMS targets on motor symptoms in PD.
Methods
  A Bayesian hierarchical model was built to assess the effects across different TMS targets, the rank probabilities and the surface under the cumulative ranking curve (SUCRA) values were calculated to determine the ranks of each target. The primary outcome was Unified Parkinson’s Disease Rating Scale part-III. Inconsistency between direct and indirect comparisons was assessed using the node-splitting method.
Results
  36 trials with 1122 subjects were included for analysis. The pair-wise meta-analysis results showed that TMS could significantly improve motor symptoms in PD patients. Network meta-analysis results showed that the high-frequency stimulation targeting bilateral M1, bilateral DLPFC, and M1+DLPFC could significantly reduce the UPDRS-III scores compared with sham conditions. The high frequency stimulation over both M1 and DLPFC had a more significant effect when compared with other parameters, and ranked first with the highest SCURA value. There was no significant inconsistency between direct and indirect comparisons.
Conclusion
  Considering all parameter settings, high-frequency stimulation targeting bilateral M1 or bilateral DLPFC has a moderate beneficial effect on the improvement of motor symptoms in PD (high confidence rating). High-frequency stimulation over M1+DLPFC has a large beneficial effect and appears to be the most effective TMS parameter setting for ameliorating motor symptoms of PD patients (high confidence rating).