Berlim Marcelo T, Van Den Eynde Frederique
Assistant Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Director, Neuromodulation Research Clinic, Douglas Mental Health University Institute, Montreal, Quebec.
Assistant Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Co-Director, Neuromodulation Research Clinic, Douglas Mental Health University Institute, Montreal, Quebec.
Can J Psychiatry. 2014 Sep;59(9):487-96. doi: 10.1177/070674371405900905.
Repetitive transcranial magnetic stimulation (rTMS) applied to the dorsolateral prefrontal cortex (DLPFC) has yielded promising results as a treatment for posttraumatic stress disorder (PTSD). However, to date, no quantitative review of its clinical utility has been published.
We searched for randomized and sham-controlled trials from 1995 to March 2013 using MEDLINE, Embase, PsycINFO, CENTRAL, and SCOPUS. We then performed an exploratory random effects meta-analysis.
Studies on rTMS applied to the right DLPFC included 64 adults with PTSD. The pooled Hedges g effect size for pre and post changes in clinician-rated and self-reported PTSD symptoms were, respectively, 1.65 (P < 0.001) and 1.91 (P < 0.001), indicating significant and large-sized differences in outcome favouring active rTMS. Also, there were significant pre and post decreases with active rTMS in overall anxiety (Hedges g = 1.24; P = 0.02) and depressive (Hedges g = 0.85; P < 0.001) symptoms. Dropout rates at study end did not differ between active and sham rTMS groups. Regarding rTMS applied to the left DLPFC, there is only one study published to date (using a high frequency protocol), and its results showed that active rTMS seems to be superior overall to sham rTMS.
Our exploratory meta-analysis shows that active rTMS applied to the DLPFC seems to be effective and acceptable for treating PTSD. However, the small number of subjects included in the analyses limits the generalizability of these findings. Future studies should include larger samples and deliver optimized stimulation parameters.
重复经颅磁刺激（rTMS）应用于背外侧前额叶皮质（DLPFC）作为创伤后应激障碍（PTSD）的一种治疗方法已取得了有前景的结果。然而，迄今为止，尚未发表对其临床效用的定量综述。
我们使用MEDLINE、Embase、PsycINFO、CENTRAL和SCOPUS检索了1995年至2013年3月期间的随机和假对照试验。然后我们进行了探索性随机效应荟萃分析。
关于rTMS应用于右侧DLPFC的研究纳入了64名患有PTSD的成年人。临床医生评定和自我报告的PTSD症状前后变化的合并Hedges g效应量分别为1.65（P < 0.001）和1.91（P < 0.001），表明在有利于活性rTMS的结果方面存在显著且较大的差异。此外，活性rTMS在总体焦虑（Hedges g = 1.24；P = 0.02）和抑郁（Hedges g = 0.85；P < 0.001）症状方面前后均有显著下降。活性和假rTMS组在研究结束时的脱落率没有差异。关于rTMS应用于左侧DLPFC，迄今为止仅发表了一项研究（使用高频方案），其结果表明活性rTMS总体上似乎优于假rTMS。
我们的探索性荟萃分析表明，应用于DLPFC的活性rTMS似乎对治疗PTSD有效且可接受。然而，分析中纳入的受试者数量较少限制了这些发现的可推广性。未来的研究应纳入更大的样本并提供优化的刺激参数。
