Effects of Repetitive Transcranial Magnetic Stimulation on Ataxia, Motor, and Psychological Outcomes in Multiple System Atrophy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

内容摘要

Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by autonomic dysfunction, parkinsonism, and cerebellar ataxia. Repetitive transcranial magnetic stimulation (rTMS) may provide therapeutic benefits; however, evidence remains limited. We aimed to evaluate the effects of rTMS on ataxia, motor, and psychological outcomes in MSA. Two investigators independently searched PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to February 2025. Randomized controlled trials (RCTs) evaluating the effects of rTMS in MSA were included. Primary outcome was Scale for the Assessment and Rating of Ataxia. Six RCTs involving 140 patients were included. rTMS significantly improved ataxia (mean difference [MD]: -6.26, 95% confidence interval [CI]: -8.52 to -4, P<0.001), motor function (MD: -1.95, 95% CI: -3.91 to 0, P=0.05), anxiety (MD: -6.43, 95% CI: -10.08 to -2.77, P<0.001), depression (standardized MD: -0.99, 95% CI: -1.6 to -0.38, P=0.001), and fatigue (MD: -13.03, 95% CI: -19.18 to -6.87, P<0.001). rTMS may improve ataxia, motor function, anxiety, depression, and fatigue in patients with MSA. Given the limited treatment options, rTMS may represent a promising noninvasive adjunctive treatment option; however, further RCTs are needed.