Spinocerebellar ataxias (SCA), comprising various genetic neurodegenerative disorders, primarily manifest through cerebellar degeneration. This leads to worsening coordination, thereby complicating daily activities such as walking and speaking. Symptoms usually emerge during adulthood, progressively worsening over time. Cannot find cure for SCA prompts researchers to explore new therapeutic avenues. One promising approach, repetitive transcranial magnetic stimulation (rTMS), a non-invasive procedure, may play a crucial role in improving patient outcomes.
Research Objective and Study Methodology
Researchers aimed to assess rTMS’s effectiveness and safety in SCA patients. A comprehensive literature review was conducted using databases: Medline, Embase, Cochrane CENTRAL, PEDRO, and WOS, among others. The study also considered sources like TripDataBase and several European health technology assessment agencies. Clinical trials in any language evaluating rTMS effects on efficacy (motor skills, posture, gait, and quality of life) and safety (treatment tolerance and adverse effects) were included. Two independent reviewers screened studies and extracted relevant data, employing the Cochrane Collaboration’s Risk of Bias tool for bias assessment when possible. A meta-analysis using a random effects model estimated the statistical heterogeneity, and GradePro was used to evaluate evidence quality.
Key Findings and Observations
Nine clinical trials with 300 patients between 2018 and 2024, across Asia, America, and Europe, were included. The mean age ranged from 34 to 53 years, and initial ataxia severity scores were 13.3 (±6.4) and 34.7 (±18.0) on the SARA and ICARS scales, respectively. Different rTMS modalities and parameters (intensity, duration, sessions) were evaluated, using sham rTMS as the comparator. Patient follow-ups ranged from immediately post-treatment to four weeks later. The cumulative analysis revealed significant rTMS advantages over sham in reducing overall ataxia symptoms.
– rTMS led to measurable improvements in SARA and ICARS scores in ataxia symptom severity.
– Noteworthy advancements were seen in ICARS subdomains: posture, gait, limb function, and eye movement disorders.
– The treatment displayed moderate to low tolerability with minor adverse effects like mild headaches and nausea.
The studies examined different rTMS stimulation modalities and parameters, and evaluations indicated moderate effect sizes in some patient subgroups. However, variability and imbalance persist across studies, limiting generalizability. The impact of variables like the stimulation type or duration remains inconclusive. No serious adverse events were reported, affirming rTMS’s safety profile. Some evidence suggests potential enhanced outcomes in SCA3 patients, but further studies are required to validate these findings.
Low to very low-certainty evidence suggests rTMS may offer slight improvements in motor skills, posture, gait, and limb function for SCA patients immediately post-stimulation. The modality is generally well-tolerated with a minimal adverse event profile. However, low-quality evidence fails to demonstrate significant rTMS advantages in improving specific subdomains related to speech disorders. The current evidence inadequately assesses rTMS’s long-term impacts and quality of life outcomes, necessitating more rigorous studies with extended follow-ups to address biases effectively.
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