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The objective of this meta-analysis was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression in patients with Parkinson disease in order to arrive at qualitative and quantitative conclusions about the efficacy of rTMS. We included randomized controlled trials examining the effects of rTMS compared with sham-rTMS or selective serotonin re-uptake inhibitors (SSRIs). The quality of included studies was strictly evaluated. Data analyses were performed using the RevMan5.1 software. Eight studies including 312 patients met all inclusion criteria. The results showed that rTMS could evidently improve the HRSD score compared with sham-rTMS (p < 0.00001). However, we found similar antidepressant efficacy between rTMS and SSRIs groups in terms of HRSD and BDI score (p = 0.65; p = 0.75, respectively). Furthermore, patients who received rTMS could evidently show improvement on the unified Parkinson's disease rating scale (UPDRS), ADL score, and UPDRS motor score compared with sham-rTMS or SSRIs (p < 0.05, p = 0.05, respectively). The subgroup analysis by frequency of rTMS evidenced that the efficacy of low-frequency rTMS was superior to sham-rTMS (p < 0.0001) in terms of the outcome measure according to HAMD scale. Meanwhile, the high-frequency rTMS has the same antidepressant efficacy as SSRIs (p = 0.94). The current meta-analysis provided evidence that rTMS was superior to sham-rTMS and had similar antidepressant efficacy as SSRIs, and may have the additional advantage of some improvement in motor function. [ABSTRACT FROM AUTHOR]

To assess the long-term use of l-dopa alone vs l-dopa-sparing therapy, as initial treatment, provides the most efficient long-term control of symptoms and best quality of life for people with early Parkinson's disease (PD). PubMed; Google scholar; Cochrane Central Register of Controlled Trials and the Web of Science were searched for randomised, placebo-controlled trials (RCTs) on l-dopa alone and l-dopa sparing as initial treatment in early PD patients. We used a random effects model rather than a fixed effects model because of this takes into account heterogeneity between multi-studies. Eleven RCTs were included. The results showed that l-dopa alone could evidently improve the UPDRS part I ( p = 0.005), part II ( p < 0.0001), part III ( p < 0.0001) and UPDRS total score ( p = 0.004) compared with l-dopa-sparing therapy in PD patients. Meanwhile, a reduced risk of dyskinesia ( p < 0.0001, RR = 1.88, 95 % CI 1. 37-2.59) and wearing-off phenomenon ( p < 0.00001, RR = 1.36, 95 % CI 1. 20-1.55) in patients treated initially with l-dopa-sparing therapy compared to l-dopa has been consistently reported. What is more, we found more patients on a l-dopa-sparing therapy were more than triple as likely to discontinue treatment prematurely due to adverse events than l-dopa treatment patients (43.7 vs 15.8 %). l-Dopa alone is the most effective medication available for treating the motor symptoms of PD patients, despite the greater incidence of involuntary movements. Meanwhile, more patients on dopamine agonists or MAOBI were more likely to discontinue treatment prematurely than l-dopa alone treatment patients within the long follow-up period. [ABSTRACT FROM AUTHOR]