Assessment of Noninvasive Brain Stimulation Interventions for Negative Symptoms of Schizophrenia

经颅直流电刺激 荟萃分析 随机对照试验 脑刺激 心理干预 医学 致盲 磁刺激 精神分裂症(面向对象编程) 迷走神经电刺激 临床心理学 物理疗法 精神科 心理学 内科学 刺激 迷走神经
作者
Ping‐Tao Tseng,Bing‐Syuan Zeng,Chao‐Ming Hung,Chih‐Sung Liang,Brendon Stubbs,André F. Carvalho,André R. Brunoni,Kuan‐Pin Su,Yu‐Kang Tu,Yi‐Cheng Wu,Tien‐Yu Chen,Dian‐Jeng Li,Pao‐Yen Lin,Chih‐Wei Hsu,Yen‐Wen Chen,Mein‐Woei Suen,Kazumi Satogami,Shun Takahashi,Ching-Kuan Wu,Wei‐Cheng Yang,Yow‐Ling Shiue,Tiao-Lai Huang,Cheng‐Ta Li
出处
期刊:JAMA Psychiatry [American Medical Association]
卷期号:79 (8): 770-770 被引量:71
标识
DOI:10.1001/jamapsychiatry.2022.1513
摘要

Negative symptoms have a detrimental impact on functional outcomes and quality of life in people with schizophrenia, and few therapeutic options are considered effective for this symptomatic dimension. Studies have suggested that noninvasive brain stimulation (NIBS) interventions may be effective in treating negative symptoms. However, the comparative efficacy of different NIBS protocols for relieving negative symptoms remains unclear.To compare the efficacy and acceptability of different NIBS interventions for treating negative symptoms.The ClinicalKey, Cochrane CENTRAL, Embase, ProQuest, PubMed, ScienceDirect, ClinicalTrials.gov, and Web of Science electronic databases were systematically searched from inception through December 7, 2021.A frequentist model network meta-analysis was conducted to assess the pooled findings of trials that evaluated the efficacy of repetitive transcranial magnetic stimulation (rTMS), theta-burst stimulation, transcranial random noise stimulation, transcutaneous vagus nerve stimulation, and transcranial direct current stimulation on negative symptoms in schizophrenia. Randomized clinical trials (RCTs) examining NIBS interventions for participants with schizophrenia were included.The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Data were independently extracted by multiple observers. The pair-wise meta-analytic procedures were conducted using a random-effects model.The coprimary outcomes were changes in the severity of negative symptoms and acceptability (ie, dropout rates owing to any reason). Secondary outcomes were changes in positive and depressive symptoms.Forty-eight RCTs involving 2211 participants (mean [range] age, 38.7 [24.0-57.0] years; mean [range] proportion of female patients, 30.6% [0%-70.0%]) were included. Compared with sham control interventions, excitatory NIBS strategies (standardized mean difference [SMD]: high-definition transcranial random noise stimulation, -2.19 [95% CI, -3.36 to -1.02]; intermittent theta-burst stimulation, -1.32 [95% CI, -1.88 to -0.76]; anodal transcranial direct current stimulation, -1.28 [95% CI, -2.55 to -0.02]; high-frequency rTMS, -0.43 [95% CI, -0.68 to -0.18]; extreme high-frequency rTMS, -0.45 [95% CI, -0.79 to -0.12]) over the left dorsolateral prefrontal cortex with or without other inhibitory stimulation protocols in the contralateral regions of the brain were associated with significantly larger reductions in negative symptoms. Acceptability did not significantly differ between the groups.In this network meta-analysis, excitatory NIBS protocols over the left dorsolateral prefrontal cortex were associated with significantly large improvements in the severity of negative symptoms. Because relatively few studies were available for inclusion, additional well-designed, large-scale RCTs are warranted.
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