Zhou Liang, Guo Zhiwei, Xing Guoqiang, Peng Haitao, Cai Mengjie, Chen Huaping, McClure Morgan A, He Lin, Xiong Liangwen, He Bin, Du Fei, Mu Qiwen
Department of Radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China.
School of Clinical Medicine,The Clinical Medical College of Southwest Medical University, Luzhou, China.
Front Psychiatry. 2019 Jan 29;9:769. doi: 10.3389/fpsyt.2018.00769. eCollection 2018.
The purpose of this meta-analysis was to investigate the antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) over the prefrontal cortex (PFC) of patients with Parkinson's disease (PD) and to determine the optimal rTMS parameters, such as the intensity, frequency and the delivered pattern of rTMS stimulation. EMBASE, PubMed, Web of Science, MEDLINE, and Cochrane data bases were researched for papers published before March 12, 2018. Studies investigating the anti-depression effects of rTMS over PFC in patients with PD were considered. The main outcomes of pre- and post-rTMS treatment as well as score changes were all extracted. The mean effect size was estimated by calculating the standardized mean difference (SMD) with 95% confidence interval (CI) by using fixed or random effect models as appropriate. Nine studies containing 137 PD patients with depression were included. The pooled results showed significant pre-post anti-depressive effects of rTMS over PFC in PD patients with depression (SMD = -0.80, < 0.00001). The subgroup analyses of stimulation intensity, frequencies, and models also revealed significant effects (Intensities: 90% RMT: SMD = -1.16, = 0.0006; >100% RMT: SMD = -0.82, < 0.0001. Frequencies: < 1.0 Hz: SMD = -0.83, = 0.03; 5.0 Hz: SMD = -1.10, < 0.0001; ≥10.0 Hz: SMD = -0.55, = 0.02. Models: Continuous: SMD = -0.79, < 0.0001; Discontinuous: SMD = -0.84, = 0.02). But the results of the studies with place-controlled designs were not significant (Overall: SMD = -0.27, = 0.54. Intensities: 90% RMT: SMD = 0.27, = 0.68; 100% RMT: SMD = -0.32, = 0.33. Frequencies: 5.0 Hz: SMD = -0.87, = 0.10; ≥10.0 Hz: SMD = 0.27, = 0.66. Models: Continuous: SMD = -0.28, = 0.68; Discontinuous: SMD = -0.32, = 0.33). The greater effect sizes of rTMS with 90% RMT, 5.0 Hz in discontinuous days can be observed rather than the other parameters in both kinds of analyses across study design. rTMS may have a significant positive pre-post anti-depressive effect over PFC on patients with depression, especially by using 5.0 Hz frequency with 90% RMT intensity in discontinuous days, which may produce better effects than other parameters. The real effect, though, was not different from that of the placebo. Future studies with larger sample sizes and high-quality studies are needed to further corroborate our results and to identify the optimal rTMS protocols.
本荟萃分析的目的是研究重复经颅磁刺激（rTMS）对帕金森病（PD）患者前额叶皮质（PFC）的抗抑郁作用，并确定最佳的rTMS参数，如rTMS刺激的强度、频率和发放模式。检索了EMBASE、PubMed、Web of Science、MEDLINE和Cochrane数据库中2018年3月12日前发表的论文。纳入研究PD患者中rTMS对PFC抗抑郁作用的研究。提取rTMS治疗前后的主要结局以及评分变化。采用固定效应模型或随机效应模型，通过计算标准化均数差（SMD）及95%置信区间（CI）来估计平均效应量。纳入9项研究，共137例伴抑郁的PD患者。汇总结果显示，rTMS对伴抑郁的PD患者PFC有显著的抗抑郁前后效应（SMD = -0.80，< 0.00001）。刺激强度、频率和模式的亚组分析也显示有显著效应（强度：90%静息运动阈值[RMT]：SMD = -1.16，P = 0.0006；>100%RMT：SMD = -0.82，< 0.0001。频率：< 1.0 Hz：SMD = -0.83，P = 0.03；5.0 Hz：SMD = -1.10，< 0.0001；≥10.0 Hz：SMD = -0.55，P = 0.02。模式：连续：SMD = -0.79，< 0.0001；间断：SMD = -0.84，P = 0.02）。但采用安慰剂对照设计的研究结果无显著性差异（总体：SMD = -0.27，P = 0.54。强度：90%RMT：SMD = 0.27，P = 0.68；100%RMT：SMD = -0.32，P = 0.33。频率：5.0 Hz：SMD = -0.87，P = 0.10；≥10.0 Hz：SMD = 0.27，P = 0.66。模式：连续：SMD = -0.28，P = 0.68；间断：SMD = -0.32，P = 0.33）。在两种研究设计的分析中，均可观察到90%RMT、间断日5.0 Hz的rTMS效应量大于其他参数。rTMS对伴抑郁患者的PFC可能有显著的抗抑郁前后正向效应，尤其是在间断日采用90%RMT强度、5.0 Hz频率时，其效果可能优于其他参数。然而，实际效果与安慰剂无异。需要更大样本量的未来研究和高质量研究来进一步证实我们的结果，并确定最佳的rTMS方案。
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