经颅直流电刺激对改善精神分裂症阴性症状的中度影响：对照试验的荟萃分析。
Moderate effects of noninvasive brain stimulation of the frontal cortex for improving negative symptoms in schizophrenia: Meta-analysis of controlled trials.
机构信息
Shenzhen Key Laboratory of Affective and Social Cognitive Science, Shenzhen University, Shenzhen, 518060, China; University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, The Netherlands; University of Groningen, Department of Clinical and Developmental Neuropsychology, Groningen, The Netherlands.
University of Groningen, Department of Clinical and Developmental Neuropsychology, Groningen, The Netherlands.
出版信息
Neurosci Biobehav Rev. 2018 Jun;89:111-118. doi: 10.1016/j.neubiorev.2018.02.009. Epub 2018 Feb 19.
BACKGROUND
Negative symptoms in schizophrenia concern a clinically relevant reduction of goal-directed behavior that strongly and negatively impacts daily functioning. Existing treatments are of marginal effect and novel approaches are needed. Noninvasive neurostimulation by means of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are novel approaches that may hold promise.
OBJECTIVES
To provide a quantitative integration of the published evidence regarding effects of rTMS and tDCS over the frontal cortex on negative symptoms, including an analysis of effects of sham stimulation.
METHODS
Meta-analysis was applied, using a random effects model, to calculate mean weighted effect sizes (Cohen's d). Heterogeneity was assessed by using Cochrans Q and I tests.
RESULTS
For rTMS treatment, the mean weighted effect size compared to sham stimulation was 0.64 (0.32-0.96; k = 22, total N = 827). Studies with younger participants showed stronger effects as compared to studies with older participants. For tDCS studies a mean weighted effect size of 0.50 (-0.07 to 1.07; k = 5, total N = 134) was found. For all frontal noninvasive neurostimulation studies together (i.e., TMS and tDCS studies combined) active stimulation was superior to sham, the mean weighted effect size was 0.61 (24 studies, 27 comparisons, 95% confidence interval 0.33-0.89; total N = 961). Sham rTMS (baseline - posttreatment comparison) showed a significant improvement of negative symptoms, d = 0.31 (0.09-0.52; k = 16, total N = 333). Whereas previous meta-analyses were underpowered, our meta-analysis had a power of 0.87 to detect a small effect.
CONCLUSIONS
The available evidence indicates that noninvasive prefrontal neurostimulation can improve negative symptoms. This finding suggests a causal role for the lateral frontal cortex in self-initiated goal-directed behavior. The evidence is stronger for rTMS than for tDCS, although this may be due to the small number of studies as yet with tDCS. More research is needed to establish moderator variables that may affect response to neurostimulation and to optimize treatment parameters in order to achieve stable and durable (and thus clinically relevant) effects.
背景
精神分裂症的阴性症状涉及到目标导向行为的临床相关减少，这强烈且消极地影响日常功能。现有的治疗方法效果有限，需要新的方法。非侵入性神经刺激，如重复经颅磁刺激(rTMS)和经颅直流电刺激(tDCS)，是可能有希望的新方法。
目的
提供关于经颅磁刺激和经颅直流电刺激前额皮层对阴性症状影响的已发表证据的定量综合，包括对假刺激效应的分析。
方法
使用随机效应模型进行荟萃分析，计算平均加权效应大小(Cohen's d)。使用 Cochrans Q 和 I 检验评估异质性。
结果
与假刺激相比，rTMS 治疗的平均加权效应大小为 0.64(0.32-0.96; k=22，总 N=827)。与年龄较大的参与者相比，年轻参与者的研究显示出更强的效果。对于 tDCS 研究，发现平均加权效应大小为 0.50(-0.07 至 1.07; k=5，总 N=134)。对于所有前额非侵入性神经刺激研究(即 TMS 和 tDCS 研究的组合)，活性刺激优于假刺激，平均加权效应大小为 0.61(24 项研究，27 项比较，95%置信区间 0.33-0.89; 总 N=961)。假 rTMS(基线-治疗后比较)显示阴性症状显著改善，d=0.31(0.09-0.52; k=16，总 N=333)。虽然以前的荟萃分析的效力不足，但我们的荟萃分析的效力为 0.87，足以检测到小的效果。
结论
现有证据表明，非侵入性前额叶神经刺激可以改善阴性症状。这一发现表明，外侧前额叶皮层在自我启动的目标导向行为中起着因果作用。rTMS 的证据比 tDCS 更有力，尽管这可能是由于目前 tDCS 的研究数量较少。需要更多的研究来确定可能影响神经刺激反应的调节变量，并优化治疗参数，以达到稳定和持久(因此具有临床相关性)的效果。
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