Network Meta-Analysis Of The Efficacy Of Three Non-Invasive Brain Stimulation Methods On Patients With Unilateral Neglect After Stroke

Background: Unilateral spatial neglect(USN)is a common behavioral cognitive impairment in poststroke patients.In recent years,with the clinical application and promotion of noninvasive Brian stimulation(NIBS),many scholars have been attracted to explore its effect in the rehabilitation of various dysfunctions in post-stroke patients.At present,many researchers at home and abroad apply different NIBS,such as transcranial direct current stimulation(tDCS)and repetitive transcranial magnetic stimulation(rTMS),to the rehabilitation of patients with unilateral neglect.There are certain differences in ignorance.Objective: To evaluate three different noninvasive brain stimulation techniques by network metaanalysis: anodal transcranial direct current stimulation(anodal tDCS),low-frequency repetitive transcranial magnetic stimulation(LF-rTMS),high-frequency repetitive transcranial magnetic stimulation(HF-rTMS)Treatment effects in patients with unilateral neglect after stroke.Methods: PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),China Biology Medicine Database(CBM),VIP Journal Database(VIP),and Wan fang Database were searched to collect information on three different non-invasive brain stimulation programs.Randomized controlled trials on improving unilateral neglect after stroke.The search time was from the establishment of the database to November 25,2022.The search language was limited to Chinese and English,and the search was done using free words combined with subject terms.Two researchers screened the literature strictly according to the inclusion and exclusion criteria and used the RoB2(2019revision)tool to assess the risk of bias of the included literature and used the mean(Mean)± standard deviation(Standard Deviation SD)to analyze the outcome indicators.Extract,and use Stata14 software for network meta-analysis,and draw various evidence charts.Results: Finally,18 studies with 797 patients were included.The results of network meta-analysis showed that under the outcome index of bisection line segment test(LBT),the curative effects of the three non-invasive brain stimulation measures were better than those of the control group(SMD<0,95%CI does not include 0);but the three intervention measures There was no statistical significance in the pairwise comparison results between the two groups;under the line segmentation test(LCT)outcome index,the pairwise comparison results showed that the efficacy of LF-rTMS was better than that of the control group(SMD<0,95%CI does not include 0);The pairwise comparison results among the three interventions were not statistically significant;the pairwise comparison results under the Catherine-Bogo Scale(CBS)outcome indicators showed that the curative effect of HF-rTMS was better than that of the control group(SMD<0,95 %CI does not include 0);among the three interventions,the efficacy of HF-rTMS is superior to that of tDCS and LF-rTMS(SMD<0,95%CI does not include 0);pairwise comparisons under the behavioral neglect test(BIT)outcome index The results showed that the curative effect of LF-rTMS was superior to that of the control group(SMD>0,95%CI does not include 0);the pairwise comparison results among the three interventions were not statistically significant;pairwise comparisons were made under the clock drawing test outcome indicators The results showed that the curative effect of LF-rTMS was better than that of the control group(SMD<0,95%CI does not include 0);there was no statistical significance in the pairwise comparison among the three interventions.With different outcome indicators as reference standards,the areas under the cumulative ranking probability curves of different interventions for USN patients were: LBT: HF-rTMS(93.4%)> LF-rTMS(58.0%)> tDCS(48.3%))> conventional treatment(0.3%);LCT: LF-rTMS(91.0%)> tDCS(49.4%)> HF-rTMS(47.2%)> conventional treatment(12.4%);CBS: HF-rTMS(99.6%)> LF-rTMS(59.3%)> tDCS(24.8%)> conventional treatment(16.3%);BIT: LFrTMS(80.0%)> HF-rTMS(67.4%)> tDCS(48.7%)> conventional treatment(3.9%));clock drawing test: LF-rTMS(86.6%)> HF-rTMS(53.1%)> tDCS(40.8%)> conventional treatment(19.5%).Conclusion: Under the reference standards of LBT,LCT,CBS,BIT,and clock-drawing test,the interventions with the best curative effect on USN patients are: HF-rTMS,LF-rTMS,HF-rTMS,LF-rTMS,LF-rTMS;Non-invasive brain stimulation technology has a positive therapeutic effect on USN patients after stroke,and rTMS is generally more effective than tDCS.