Kekic Maria, Boysen Elena, Campbell Iain C, Schmidt Ulrike
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK.
J Psychiatr Res. 2016 Mar;74:70-86. doi: 10.1016/j.jpsychires.2015.12.018. Epub 2015 Dec 22.
Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique, which can be used to selectively disrupt patterns of neural activity that are associated with symptoms of mental illness. tDCS has been implemented in numerous therapeutic trials across a range of patient populations, with a rapidly increasing number of studies being published each year. This systematic review aimed to evaluate the efficacy of tDCS in the treatment of psychiatric disorders. Four electronic databases were searched from inception until December 2015 by two independent reviewers, and 66 eligible studies were identified. Depression was the most extensively researched condition, followed by schizophrenia and substance use disorders. Data on obsessive compulsive disorder, generalised anxiety disorder, and anorexia nervosa were also obtained. The quality of included studies was appraised using a standardised assessment framework, which yielded a median score corresponding to "weak" on the three-point scale. This improved to "moderate" when case reports/series were excluded from the analysis. Overall, data suggested that tDCS interventions comprising multiple sessions can ameliorate symptoms of several major psychiatric disorders, both acutely and in the long-term. Nevertheless, the tDCS field is still in its infancy, and several methodological and ethical issues must be addressed before clinical efficacy can truly be determined. Studies probing the mechanisms of action of tDCS and those facilitating the definition of optimised stimulation protocols are warranted. Furthermore, evidence from large-scale, multi-centre randomised controlled trials is required if the transition of this therapy from the laboratory to the clinic is to be considered.
经颅直流电刺激(tDCS)是一种非侵入性神经调节技术,可用于选择性地破坏与精神疾病症状相关的神经活动模式。tDCS已在众多患者群体的治疗试验中得到应用,每年发表的研究数量迅速增加。本系统评价旨在评估tDCS治疗精神疾病的疗效。两名独立 reviewers 从数据库建立至2015年12月对四个电子数据库进行了检索,共识别出66项符合条件的研究。抑郁症是研究最广泛的疾病,其次是精神分裂症和物质使用障碍。还获取了关于强迫症、广泛性焦虑症和神经性厌食症的数据。使用标准化评估框架对纳入研究的质量进行评估,在三分制量表上得出的中位数分数对应于“弱”。当将病例报告/系列排除在分析之外时,这一分数提高到了“中等”。总体而言,数据表明,多次 sessions 的tDCS干预可在短期和长期内改善几种主要精神疾病的症状。然而,tDCS领域仍处于起步阶段,在真正确定临床疗效之前,必须解决几个方法学和伦理问题。有必要开展研究以探究tDCS的作用机制,并促进优化刺激方案的定义。此外,如果要考虑将这种疗法从实验室推广到临床,还需要大规模、多中心随机对照试验的证据。
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