ABSTRACT
Objective To evaluate the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke depression (PSiD).Methods The Cochrane Library,Medline,EMbase and CBMdisc were electronically searched for reports of randomized and controlled trials (RCTs) of high-frequency rTMS in the treatment of PSD before October 2017.Two researchers screened the reports independently,extracted data and assessed the risk of bias in the included studies.The meta-analysis was performed using version 5.1 of the RevMan software.Results A total of 26 RCTs were included,covering 1810 patients with PSD.The metaanalysis showed that the remission rate [relative risk (RR) =2.15,95％CI (1.64,2.83)] and the effectiveness [RR =1.66,95％CI (1.28,2.15)] of high-frequency rTMS group were significantly higher than in the control groups.Compared with the control group,the average Hamilton depression rating scale (HAMD) score of the high-frequency rTMS groups was significantly lower than in the control groups.There was no significant difference in withdrawal between the two groups after treatment [RR =0.55,95％CI (0.18,1.65)].The incidence of headaches was significantly higher in the high-frequency rTMS group than among the controls.Conclusion High-frequency rTMS has a good curative effect and better acceptability for PSD patients,but attention should be given to headaches and other adverse reactions.Due to the limited number of studies and their quality,these conclusions still need to be verified in betterquality studies.
ABSTRACT
Objective To evaluate the efficacy and safety of intra-arterial thrombolysis with recombinant tissue-plasminogen ac-tivator(rt-RA) for treatment of acute cerebral infarction (ACI) .Methods The randomized controlled trials (RCT ) of intra-arterial thrombolysis with rt-PA for treatment of ACI were selected from Cochrane Library ,Medline ,Embase and CBM by the computer re-trieval .A meta analysis of the data were analyzed by using RevMan 5 .1 software .Results A total of 473 patients in 9 selected RCTs were involved in the systematic review .Meta-analysis results disclosed suggested that the effectiveness of intra-arterial thrombolysis treated ACI group was better than that of intravenous thrombolysis group [RR= 1 .26 ,95% CI(1 .09 ,1 .45) ,P=0 .002] .No difference was observed between the two groups in intracranial hemorrhage and mortality rate .Conclusion The current evidence showed that ,the clinical effect of intra-arterial thrombolysis with rt-PA for treatment of ACI was obviously superior to that of intravenous thrombolysis ,but the result still needs to be confirmed by large-sample RCTs .