Department of Psychiatry, Icahn School of Medicine at Mount Sinai, USA.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, USA.
Eur Psychiatry. 2018 Mar;49:69-77. doi: 10.1016/j.eurpsy.2017.12.025. Epub 2018 Feb 3.
Transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) have shown promise in the treatment of schizophrenia.
To quantify the efficacy of double-blind randomized controlled trials (RCT) of tDCS and rTMS for the positive and negative symptoms of schizophrenia and identify significant moderators relating to patient-related features and stimulation parameters.
Systemic review and meta-analyses of the relevant literature published until February 1st, 2017 to assess treatment efficacy and quantify the contribution of potential moderator variables.
We identified 7 RCTs on tDCS (involving 105 participants) and 30 RCTs on rTMS (involving 768 participants). Compared to sham, tDCS improved all symptom dimensions but the effect reached significance for negative symptoms (Hedge's g = -0.63, p = 0.02). Efficacy for positive but not negative symptoms was linearly associated with cumulative tDCS stimulation. Compared to sham, rTMS improved hallucinations (Hedge's g = -0.51, p < 0.001) and negative symptoms (Hedge's g = -0.49, p = 0.01) but was associated with modest, non-significant worsening of positive symptoms (Hedge's g = 0.28, p = 0.13). Higher pulse frequency (>10 Hz), motor threshold intensity of 110%, left prefrontal cortical treatment site and trial duration over 3 weeks were associated with improvement in negative symptoms and worsening in positive symptoms (all p < 0.03).
The symptom dimensions in schizophrenia may respond differently to brain stimulation interventions in a way that may reflect the interaction between disease- and treatment-related mechanisms. Our findings underscore the need for further research into patient selection prior to treatment assignment and greater refinement of stimulation protocols.
经颅直流电刺激（tDCS）和重复经颅磁刺激（rTMS）已显示出治疗精神分裂症的潜力。
量化 tDCS 和 rTMS 治疗精神分裂症阳性和阴性症状的双盲随机对照试验（RCT）的疗效，并确定与患者相关特征和刺激参数相关的显著调节因素。
系统回顾和荟萃分析截至 2017 年 2 月 1 日发表的相关文献，以评估治疗效果并量化潜在调节变量的贡献。
我们确定了 7 项 tDCS 的 RCT（涉及 105 名参与者）和 30 项 rTMS 的 RCT（涉及 768 名参与者）。与假刺激相比，tDCS 改善了所有症状维度，但对阴性症状的效果达到显著水平（Hedge's g= -0.63，p= 0.02）。阳性症状但不是阴性症状的疗效与累积 tDCS 刺激呈线性相关。与假刺激相比，rTMS 改善了幻觉（Hedge's g= -0.51，p<0.001）和阴性症状（Hedge's g= -0.49，p= 0.01），但与阳性症状的适度但无显著恶化相关（Hedge's g= 0.28，p= 0.13）。更高的脉冲频率（>10 Hz）、110%的运动阈值强度、左前额皮质治疗部位和 3 周以上的试验持续时间与阴性症状的改善和阳性症状的恶化相关（所有 p<0.03）。
精神分裂症的症状维度可能以反映疾病和治疗相关机制相互作用的方式对脑刺激干预有不同的反应。我们的研究结果强调了在治疗分配前进一步研究患者选择和更精细地调整刺激方案的必要性。
