Trevizol Alisson Paulino, Barros Mirna Duarte, Silva Paula Oliveira, Osuch Elizabeth, Cordeiro Quirino, Shiozawa Pedro
Centro Interdisciplinar de Neuromodulação Clínica, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil.
Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario, Canada.
Trends Psychiatry Psychother. 2016 Jan-Mar;38(1):50-5. doi: 10.1590/2237-6089-2015-0072.
Transcranial magnetic stimulation (TMS) is a promising non-pharmacological intervention for posttraumatic stress disorder (PTSD). However, randomized controlled trials (RCTs) and meta-analyses have reported mixed results.
To review articles that assess the efficacy of TMS in PTSD treatment.
A systematic review using MEDLINE and other databases to identify studies from the first RCT available up to September 2015. The primary outcome was based on PTSD scores (continuous variable). The main outcome was Hedges' g. We used a random-effects model using the statistical packages for meta-analysis available in Stata 13 for Mac OSX. Heterogeneity was evaluated with I2 (> 35% for heterogeneity) and the χ2 test (p < 0.10 for heterogeneity). Publication bias was evaluated using a funnel plot. Meta-regression was performed using the random-effects model.
Five RCTs (n = 118) were included. Active TMS was significantly superior to sham TMS for PTSD symptoms (Hedges' g = 0.74; 95% confidence interval = 0.06-1.42). Heterogeneity was significant in our analysis (I2 = 71.4% and p = 0.01 for the χ2 test). The funnel plot shows that studies were evenly distributed, with just one study located marginally at the edge of the funnel and one study located out of the funnel. We found that exclusion of either study did not have a significant impact on the results. Meta-regression found no particular influence of any variable on the results.
Active TMS was superior to sham stimulation for amelioration of PTSD symptoms. Further RCTs with larger sample sizes are fundamental to clarify the precise impact of TMS in PTSD.
经颅磁刺激（TMS）是一种很有前景的用于创伤后应激障碍（PTSD）的非药物干预方法。然而，随机对照试验（RCT）和荟萃分析报告的结果不一。
回顾评估TMS治疗PTSD疗效的文章。
采用MEDLINE和其他数据库进行系统综述，以识别从首个RCT到2015年9月的研究。主要结局基于PTSD评分（连续变量）。主要效应量是Hedges' g。我们使用适用于Mac OSX的Stata 13中的荟萃分析统计软件包采用随机效应模型。用I²（I²> 35%表示存在异质性）和χ²检验（p < 0.10表示存在异质性）评估异质性。用漏斗图评估发表偏倚。采用随机效应模型进行荟萃回归。
纳入了5项RCT（n = 118）。对于PTSD症状，主动TMS显著优于假TMS（Hedges' g = 0.74；95%置信区间 = 0.06 - 1.42）。在我们的分析中异质性显著（I² = 71.4%，χ²检验p = 0.01）。漏斗图显示研究分布均匀，只有一项研究略位于漏斗边缘，一项研究位于漏斗之外。我们发现排除任何一项研究对结果均无显著影响。荟萃回归发现没有任何变量对结果有特别影响。
主动TMS在改善PTSD症状方面优于假刺激。进一步开展更大样本量的RCT对于阐明TMS对PTSD的确切影响至关重要。
