Effect of Repetitive Transcranial Magnetic Stimulation on Gait and Freezing of Gait in Parkinson Disease: A Systematic Review and Meta-analysis

Objective The purpose of this review was to systematically assess the effectiveness of repetitive transcranial magnetic stimulation (rTMS) intervention on gait in individuals with Parkinson disease (PD). Data Sources We searched online electronic databases up to March 28, 2019, including MEDLINE, Embase, the Cochrane Library, and so on. Study Selection The inclusion criteria for this review were randomized controlled trials (RCTs), exploring the effect of rTMS in patients diagnosed with idiopathic PD. Data Extraction Data extraction was performed independently by 2 reviewers based on predefined criteria and the methodologic quality of included studies was quantified by the Physiotherapy Evidence Database scale. The outcome measure was walking performance, including walking time (short term and long term), Timed Up and Go (TUG) test, and so on. Data Synthesis Among 14 eligible studies, including 298 participants (mean age ± SD [y], 63.24±9.71; 191 [64%] men) were analyzed in this meta-analysis. Walking time was improved with rTMS compared with sham rTMS (standardized mean difference [SMD] -0.30; 95% confidence interval [CI], -0.57 to -0.03; P=.03). The score for the freezing of gait questionnaire did not differ significantly between rTMS and no intervention. Four studies compared TUG between the 2 treatment groups and no significant differences were found between the rTMS and control group (SMD -0.45; 95% CI, -1.32 to 0.41; P=.30). During the off-state, there were no significant differences in estimated effect sizes (SMD=-0.29; 95% CI, -0.79 to 0.21; P=.25), which is significantly different in on-state (SMD -0.98; 95% CI, -1.78 to -0.18; P=.02) evaluation. Conclusions The results of the meta-analysis propose the favorable effect of rTMS on walking performance in the short term but not over the long term in individuals with PD.