Background Considerable evidence showed that repetitive transcranial magnetic stimulation (rTMS) can improve standing balance and walking performance in older adults with age-related neurological disorders. We here thus completed a systematic review and meta-analysis to quantitatively examine such benefits of rTMS. Methods A search strategy based on the PICOS principle was used to obtain the literature in four databases. The screening and assessments of quality and risk of bias in the included studies were independently completed by two researchers. Outcomes included scales related to standing balance, Timed Up and Go (TUG) time, and walking speed/time/distance. Results Twenty-three studies consisting of 532 participants were included, and the meta-analysis was completed on 21 of these studies. The study quality was good. Compared to control, rTMS induced both short-term (≤3 days after last intervention session) and long-term (≥1 month following last intervention session) significant improvements in balance scales (e.g., Berg Balance Scale), TUG time, and walking speed/time/distance (short-term: standardized mean difference [SMD]=0.26~0.34, 95% confidence interval [CI]=0.05~0.62; long-term: SMD=0.40~0.44, 95% CI=0.04~0.79) for both PD and stroke cohorts. Subgroup analyses suggested that greater than nine sessions of high-frequency rTMS targeting primary motor cortex with greater than 3000 pulses per week can maximize such benefits. Only few mild-to-moderate adverse events/side effects were reported, which were similar between rTMS and control group. Conclusion The results suggest that rTMS holds promise to improve balance and walking performance in older adults with age-related neurological disorders. Future studies with more rigorous design are needed to confirm the observations in this work.

中文翻译：

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重复经颅磁刺激对患有年龄相关神经系统疾病的老年人站立平衡和行走的影响：系统评价和荟萃分析

背景大量证据表明，重复经颅磁刺激（rTMS）可以改善患有与年龄相关的神经系统疾病的老年人的站立平衡和行走能力。因此，我们在此完成了系统回顾和荟萃分析，以定量检验 rTMS 的这些益处。方法采用基于PICOS原则的检索策略获取4个数据库中的文献。纳入研究的质量和偏倚风险的筛选和评估由两名研究人员独立完成。结果包括与站立平衡、计时起身 (TUG) 时间以及步行速度/时间/距离相关的量表。结果 纳入 23 项研究，共 532 名受试者，并对其中 21 项研究完成荟萃分析。学习质量很好。与对照相比，rTMS 使平衡量表（例如，Berg 平衡量表）、TUG 时间和步行均出现短期（上次干预后≤3 天）和长期（上次干预后≥1 个月）显着改善速度/时间/距离（短期：标准化均差[SMD]=0.26~0.34，95%置信区间[CI]=0.05~0.62；长期：SMD=0.40~0.44，95% CI=0.04~0.79 ) 对于 PD 和卒中队列。亚组分析表明，针对初级运动皮层的高频 rTMS 每周超过 3000 次脉冲，超过 9 次可以最大限度地发挥这种益处。仅报告了很少的轻度至中度不良事件/副作用，rTMS 和对照组之间相似。结论 结果表明，rTMS 有望改善患有与年龄相关的神经系统疾病的老年人的平衡和行走能力。未来的研究需要更严格的设计来证实这项工作中的观察结果。