Noninvasive brain stimulation for motor function and quality of life in Parkinson's disease: a systematic review and network meta-analysis.

BACKGROUND

Parkinson's disease (PD) seriously affects the motor function and quality of life of patients. Noninvasive brain stimulation (NIBS) is an effective non-pharmacological approach to improve the motor function and quality of life of PD patients, but the views about the optimal NIBS intervention remain controversial. This study aimed to compare and rank the relative efficacy of different NIBS interventions on motor function and quality of life.

METHODS

Eight databases, including PubMed, Cochrane Library, Embase, Web of Science, SinoMed, CNKI, Wanfang, and VIP Database, were systematically searched from inception to 15 December 2025. Randomized controlled trials (RCTs) using NIBS in PD treatment were included. Mean difference (MD) and 95 % confidence interval (95 % CI) were used as effect indicators, and P < 0.05 was considered statistically significant. Pairwise meta-analysis was performed using RevMan 5.4, and network meta-analysis was conducted using Stata 16.0.

RESULTS

A total of 45 RCTs involving 2,354 patients with PD and 17 NIBS interventions were included. For motor function assessed using the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III), the top three interventions for short-term outcomes were cTBS-SMA (SUCRA, 91.6 %), HF-rTMS-SMA (86.6 %), and HF-rTMS-M1 (84.8 %). Compared with placebo (sham stimulation), the top-ranked cTBS-SMA significantly reduced short-term UPDRS-III scores (MD = -9.80, 95 % CI -17.55 to -2.05). For long-term UPDRS-III outcomes, the top three interventions were HF-rTMS-M1 + SMA (SUCRA, 90.4 %), HF-rTMS-SMA (83.6 %), and LF-rTMS-DLPFC (73.4 %). Compared with placebo, the top-ranked HF-rTMS-M1 + SMA significantly reduced long-term UPDRS-III scores (MD = -10.05, 95 % CI -18.67 to -1.42). For quality of life assessed using the Parkinson's Disease Questionnaire-39 (PDQ-39), the top three interventions for short-term outcomes were HF-rTMS-SMA (SUCRA, 79.9 %), HF-rTMS-M1 (78.4 %), and a-tDCS-DLPFC (57.7 %). No statistically significant difference in short-term PDQ-39 scores was observed between the top-ranked HF-rTMS-SMA and placebo (MD = -7.70, 95 % CI -16.35 to 0.95). For long-term PDQ-39 outcomes, the top three interventions were LF-rTMS-M1 (SUCRA, 72.7 %), HF-rTMS-M1 (65.5 %), and a-tDCS-DLPFC (48.4 %). No statistically significant difference in long-term PDQ-39 scores was observed between the top-ranked LF-rTMS-M1 and placebo (MD = -6.73, 95 % CI -19.79 to 6.33).

CONCLUSIONS

cTBS-SMA and HF-rTMS-M1 + SMA ranked highest for short- and long-term motor function, respectively, and were the only top-ranked interventions that were significantly superior to placebo. For quality of life, HF-rTMS-SMA and LF-rTMS-M1 ranked highest for short- and long-term outcomes, respectively, but neither was significantly superior to placebo; overall, most highly ranked interventions for quality-of-life outcomes were not statistically significant. SUCRA rankings should therefore be interpreted cautiously.