Efficacy Of Repetitve Transcranial Magnetic Stimulation For Post-stroke Depression:A Systematic Review And Meta-analysis Of Randomized Clinical Trials

Purpose: We aimed to conduct a meta-analysis to evaluate the efficacy of rTMS in patients with post-stroke depression(PSD).Patients and methods: Six relevant electronic databases(PubMed,CENTRAL,Embase,Web of Science,CINAHL,and PsycINFO)was searched.Randomized controlled trials(RCTs)that compared rTMS interventions with control conditions in PSD were included.The retrieval literature was screened and re-screened according to the inclusion and exclusion criteria,the clinical data of primary and secondary outcomes were collected for meta-analysis,and bias risk of trials was evaluated.Result: In total 7 RCTS with 351 participants were included.At posttreatment,rTMS was significantly more effective than the control conditions,with a standardized mean difference(SMD)of-1.15,and remission with a odds ratio(OR)of 3.46.As for the stroke recovery,rTMS was also better than control conditions(SMD=-0.67,95% credible interval [CI]-1.02 to-0.32;P<0.001).But there was no statistically significant difference between rTMS intervention and control conditions for cognitive function recovery(SMD=4.07,95%CI-1.41 to 9.55;P=0.15).In order to explore the potential moderators that may affect the results of the primary efficacy outcome,a series of subgroup analyses and sensitivity analysis were conducted,we found that rTMS may be more effective in Asia group than in North America group(P=0.03).Conclusion: According to the findings in this review,rTMS may be more beneficial in treating depression in patients with stroke.Further well-defined clinical studies should be performed to confirm these outcomes.