Cerebellar Repetitive Transcranial Magnetic Stimulation for Essential Tremor: A Systematic Review and Meta-analysis
David Abraham1, Frederico De Sousa Marinho Mendes Filho1, Rebeca Silva2, Giovanna Salema Pascual3, Christian Fukunaga4, Elizabet Taylor Weba5, Luis Nogueira6, Rafaela Nascimento4, Emanuelly Barbosa1, Kenzo Ogasawara7, Leonardo Pipek8, Pablo Feitoza1
1Federal University of Amazonas, 2Federal University of Paraíba, 3University of Bologna, 4Centro Universitário FMABC, 5State University of Maranhão Tocantine Region, 6Amazonas State University, 7Bahiana School of Medicine and Public Health, 8University of São Paulo
Objective:
Aim to evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in essential tremor (ET).
Background:
Essential tremor significantly impairs patient autonomy and often responds poorly to standard pharmacological or surgical treatments. rTMS may be an option after first-line therapy failure, though its efficacy remains uncertain, requiring further investigation into its therapeutic potential and safety.
Design/Methods:
We conducted a systematic review and meta-analysis following PRISMA guidelines, extracting data from PubMed, Embase, and Cochrane databases. We included studies that compared patients with ET treated with rTSM with patients treated with shaw therapy or other therapy available. The primary outcome was the Fahn-Tolosa-Marin (FTM) total score, with secondary outcomes being the FTM subscale A (tremor severity), subscale B (motor task), and subscale C (functional disability). All of the outcomes were analyzed after 1 month of follow-up. Proportions with 95% confidence intervals (CIs) were calculated using a random-effects model. Statistical analysis was performed in RStudio version 4.2.3.
Results:
Three randomized clinical trials (RCTs) involving ET 89 patients with a mean age of 55.3 years were analyzed. rTMS significantly reduced the total FTM score (MD: -13.39; [-14.67, -12.12]; I² = 0%), demonstrating consistent efficacy. Tremor severity improved (MD: -3.03; [-5.56, -0.49]), though heterogeneity was high (I² = 87%). rTMS also enhanced motor task performance (MD: -4.70; [-6.58, -2.82]; I² = 15%) and reduced functional disability (MD: -2.99; [-3.37, -2.62]; I² = 0%), therefore, showing significant benefits across all measures.
Conclusions:
Our study demonstrates that rTMS significantly improves tremor severity, motor function, and daily activities in essential tremor patients. However, the safety profile of rTMS should be better determined in further studies. RCTs with larger patient populations are needed to optimize treatment protocols.
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