The efficacy of repetitive transcranial magnetic stimulation in patients with spinocerebellar ataxia: A systematic review and meta-analysis.

Spinocerebellar ataxia (SCA) is a group of hereditary neurodegenerative disorders characterized by the progressive incoordination of gait, impaired motor control, and various neurological deficits. Therapeutic options for SCA remain limited. However, repetitive transcranial magnetic stimulation (rTMS) has gained attention as a potential intervention due to its noninvasive nature, ease of application, and favorable safety profile. To evaluate the therapeutic efficacy of rTMS in SCA, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs). A comprehensive search of PubMed, Medline, and the Cochrane Library databases was conducted to identify RCTs assessing rTMS for SCA management. The primary outcomes of interest included changes in motor function as measured by the Scale for the Assessment and Rating of Ataxia (SARA) or the International Cooperative Ataxia Rating Scale (ICARS). Our analysis included eight RCTs involving a total of 237 participants. Meta-analysis results demonstrated statistically significant improvements in motor function. Specifically, SARA scores showed a mean difference (MD) of -1.56 (95% CI, -2.88 to -0.24; p = 0.02), and ICARS scores improved with an MD of -3.16 (95% CI, -3.93 to -2.39; p < 0.001) compared with a sham group. To evaluate the effects of different rTMS protocols on SCA, we performed subgroup analyses of low-frequency (LF), high-frequency (HF), and intermittent theta burst stimulation (iTBS). We revealed that LF (MD, -1.60; 95% CI, -3.06 to -0.13; p = 0.03) and iTBS (MD, -1.68; 95% CI, -2.29 to -1.08; p < 0.001) were effective in significantly improving SARA. The HF group showed a reduction in SARA scores (MD, -1.52; 95% CI, -6.34 to 3.30; p = 0.54) but without significance because of the small sample size. These findings indicate that overall rTMS is a promising therapeutic approach for alleviating motor symptoms in hereditary SCA patients.