Effects of different non-invasive brain stimulation protocols on gait and balance function in patients with Parkinson's disease:a network meta-analysis

Cheng Xiaofei; Yang Yuanyuan; Li Sihui; Wang Dehua; Liang Chunting; Li Jiawei; Yao Mingyang; Yao Xiaoduo; Tang Jiqin

doi:10.12307/2026.739

Abstract：OBJECTIVE:Through a network meta-analysis integrating direct and indirect evidence,this study compared the effects of different non-invasive brain stimulation techniques and parameters on gait and balance functions of patients with Parkinson's disease,and ranked the best intervention schemes. METHODS:A literature search of CNKI,WanFang,VIP,CBM,PubMed,Cochrane Library,Embase and Web of Science was conducted to screen the randomized controlled trials related to non-invasive brain stimulation for gait and balance disorders in patients with Parkinson's disease.The search time limit was up to June 16,2025.Data of the included studies were extracted for statistical processing using RevMan 5.4.1 software and Stata 17.0 software. RESULTS:(1)A total of 47 trials were conducted,involving 2 767 patients(1 399 in the trial group and 1 368 in the control group).(2)The results of traditional meta-analysis indicated that high-frequency repetitive transcranial magnetic stimulation could reduce the scores on the third part of the Unified Parkinson's Disease Rating Scale and the Freezing of Gait Questionnaire,shorten the Timed Up and Go Test time,increase step length,improve gait speed,and raise the Berg Balance Scale score,all of which were superior to conventional treatment(P<0.05).Transcranial direct current stimulation could lower the Freezing of Gait Questionnaire score,shorten the Timed Up and Go Test time,increase step length,improve gait speed,and raise the Berg Balance Scale score,all of which were superior to conventional treatment(P<0.05).Low-frequency repetitive transcranial magnetic stimulation could reduce the Unified Parkinson's Disease Rating Scale Ⅲ score,and there was a significant difference compared with conventional treatment(P<0.05).There was no statistically significant improvement in step frequency for all three methods(P>0.05);however,due to the small number of studies,further verification is required.(3)The results of the network Meta-analysis indicated that in terms of reducing the Unified Parkinson's Disease Rating Scale Ⅲ score:high-frequency repetitive transcranial magnetic stimulation targeting bilateral regions of the primary motor cortex and dorsolateral prefrontal cortex produced cumulative probability ranking is the highest(95.2％),followed by stimulation on the primary motor cortex(72.5％);in terms of shortening the Timed Up and Go Test time:high-frequency repetitive transcranial magnetic stimulation produced cumulative probability ranking was the highest on the dorsolateral prefrontal cortex(85.5％),followed by stimulation on the primary motor cortex(69.0％);in terms of improving gait speed:high-frequency repetitive transcranial magnetic stimulation produced cumulative probability ranking was the highest on the dorsolateral prefrontal cortex(92.5％),followed by stimulation on the primary motor cortex(76.7％);in terms of increasing the Berg Balance Scale score:high-frequency repetitive transcranial magnetic stimulation produced cumulative probability ranking was the highest on the primary motor cortex(79.9％),followed by transcranial direct current stimulation on the cerebellum(79.8％).(4)The GRADE evidence quality assessment results show that the evidence levels for the Unified Parkinson's Disease Rating Scale Ⅲ,Freezing of Gait Questionnaire score,Timed Up and Go Test time,and stride length were moderate,while those for gait speed,step frequency,and Berg Balance Scale score were low. CONCLUSION:Different types of non-invasive brain stimulation can all improve the gait and balance functions of patients with Parkinson's disease.High-frequency repetitive transcranial magnetic stimulation targeting the dorsolateral prefrontal cortex is superior to that targeting the primary motor cortex in improving gait function(moderate evidence),high-frequency repetitive transcranial magnetic stimulation targeting the primary motor cortex is superior to transcranial direct current stimulation targeting the cerebellum in improving balance function(low-level evidence).