Repetitive Trans-Cranial Magnetic Stimulation (rTMS) for Cognitive Enhancement in Traumatic Brain Injury (TBI) patients: A Systematic Review and Meta-analysis.
Bibliographic record
Abstract
Introduction: Earlier, Cognitive Rehabilitation Therapy (CRT) focussed on restorative or compensatory approach. It is only recently that repetitive Transcranial Magnetic Stimulation (rTMS) approach of CRT has been shown to stimulate cognitive networks to produce long lasting cognitive enhancement in Traumatic Brain Injury (TBI) patients. Objective: To determine the effectiveness of low frequency rTMS for cognitive enhancement in TBI patients. Method: PubMed (n=2), Trip Medical Database (n=6), ClinicalTrials.Gov (n=8) were searched for ‘rTMS’, ‘TBI’ & ‘cognition’. Studies identified from inception were imported to EndNote X9 Library and duplicates removed post which RCTs conducted with TBI patients (>=18 year) having undergone rTMS for Cognitive Enhancement compared against Sham controlled placebo groups were screened using Title and Abstract (n=9) and full text (n=9). Trail Making (TMT) Test Part-B & Montreal Cognitive Assessment (MoCA) Data could be extracted from 6 studies, and their meta-analysis was done in Review Manager 5.4. Result: Due to considerable heterogeneity (Chi2 = 257.44, p<0.000001, I2 = 82%), inverse variance random effect meta-analysis was done. Cognitive enhancement scores of 154 patients from 6 studies revealed a pooled Standardized Mean Difference of 0.07 [95% CI, -0.81, 0.94]. Test for overall effect Z = 0.15 (P = 0.88) indicates that there is no significant difference in cognitive outcomes between Sham controlled and rTMS patients. Overall cognitive enhancement reached statistical significance (Z = 20.53 (P < 0.00001)) in sham control favouring sub-group (fixed effect meta-analysis (I2 = 0%)) as well as in rTMS favouring sub-group (Z = 2.79 (P = 0.005)) (random effect meta-analysis (I2 = 71%)) Conclusion: The pooled evidence suggests that both interventions significantly improved cognitive outcomes among TBI patients and rTMS does not have any significant benefit over Sham controlled groups for cognitive enhancement. The meta analysis from our study shall guide treatment and future researchers.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.015 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.022 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".