SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Cognitive and Behavioral Neurology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1627932
Comparative efficacy of different modalities of transcranial magnetic stimulation for treating Parkinson's disease with depression: a systematic review and network meta-analysis
Provisionally accepted
Zhichen Wang1,2Senlin Chen1,2Qianhong Zhu2Shun Chen2Yulong Zou1Gengzhao Chen2Qiuyi Luo2
Sai’e Huang1,2,3,4*- 1Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- 2Fujian University of Traditional Chinese Medicine, Fuzhou, China
- 3Key Laboratory of Cognitive Rehabilitation of Fujian Province, Fuzhou, China
- 4Key Laboratory of Rehabilitation Technology of Fujian Province, Fuzhou, China
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Objective: Parkinson's disease (PD) is a prevalent neurodegenerative disorder. However, systematic comparisons of various transcranial magnetic stimulation (TMS) modalities for treating depression in patients with PD remain limited. This study aimed to evaluate the therapeutic effects of different TMS modalities on depression in patients with PD. Methods: A systematic search following PRISMA guidelines was conducted in the following databases: Cochrane Library, Embase, PubMed, Web of Science, CNKI, WanFang, VIP, and CBM, covering literature up to April 1, 2025. Included studies were randomized controlled trials (RCTs) evaluating TMS interventions in PD patients with depression. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 (ROB 2.0) tool. Comparative effectiveness analysis was conducted using STATA 17.0. Results: A total of thirty-five RCTs involving 2353 participants were included, evaluating high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) compared to sham stimulation and conventional rehabilitation therapy (CRT). The results showed that LF-rTMS [standardized mean difference (SMD)= -2.46, 95% confidence interval (-3.62, -1.29)], HF-rTMS [SMD =-2.05, 95% CI (-3.16, -0.94)] significantly improved depressive symptoms.The network meta-analysis indicates that both HF-rTMS and LF-rTMS may be considered as effective adjunctive therapy to improve depression in patients with PD, with LF-rTMS potentially showing superior efficacy in improving depressive symptoms. Parameters, such as total pulses no more than 1200, may optimize outcomes.However, further high-quality RCTs are required to validate these findings and refine optimal treatment protocols.
Keywords: Depression, Network meta-analysis, Parkinson's disease, parameters, Transcranial Magnetic Stimulation
Received: 13 May 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Wang, Chen, Zhu, Chen, Zou, Chen, Luo and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sai’e Huang, Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
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