Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China.
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
Transl Psychiatry. 2020 May 28;10(1):168. doi: 10.1038/s41398-020-0851-5.
Approximately 7-9% of people develop posttraumatic stress disorder in their lifetime, but standard pharmacological treatment or psychotherapy shows a considerable individual variation in their effectiveness. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) hold promise for the treatment of posttraumatic stress disorder. The objective of this meta-analysis was to summarize the existing evidence on the therapeutic effects of these brain stimulation treatments on posttraumatic core symptoms. We systematically retrieved articles published between 1st January 2000 and 1st January 2020 comparing the effects of active with sham stimulation or no intervention in posttraumatic patients from eight databases. Random-effects model was used for meta-analysis. Meta-regression and subgroup meta-analysis was performed to investigate the influence of stimulation dose and different stimulation protocols, respectively. 20 studies were included in this review, where of 11 randomized controlled trials were subjected to quantitative analysis. Active stimulation demonstrated significant reductions of core posttraumatic symptoms with a large effect size (Hedge's g = -0.975). Subgroup analysis showed that both excitatory and inhibitory rTMS of the right dorsolateral prefrontal cortex led to symptom reductions with a large (Hedges' g = -1.161, 95% CI, -1.823 to -0.499; p = 0.015) and medium effect size (Hedges' g = -0.680, 95% CI: -0.139 to -0.322; p ≤ 0.001) respectively. Results further indicated significant durability of symptom-reducing effects of treatments during a two to four weeks period post stimulation (Hedges' g = -0.909, 95% CI: -1.611 to -0.207; p = 0.011). rTMS of the right dorsolateral prefrontal cortex appears to have a positive effect in reducing core symptoms in patients with posttraumatic stress disorder.
大约有 7-9%的人在一生中会发展出创伤后应激障碍，但标准的药物治疗或心理治疗在其有效性方面显示出相当大的个体差异。重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS）有望成为创伤后应激障碍的治疗方法。本荟萃分析的目的是总结这些脑刺激治疗对创伤后核心症状的治疗效果的现有证据。我们系统地检索了 2000 年 1 月 1 日至 2020 年 1 月 1 日期间发表的文章，比较了 8 个数据库中接受主动刺激与假刺激或无干预的创伤后患者的疗效。采用随机效应模型进行荟萃分析。分别进行了元回归和亚组荟萃分析，以研究刺激剂量和不同刺激方案的影响。本综述共纳入 20 项研究，其中 11 项随机对照试验进行了定量分析。主动刺激显示核心创伤后症状显著减轻，效应量较大（Hedge's g=-0.975）。亚组分析显示，右侧背外侧前额叶皮层的兴奋性和抑制性 rTMS 均可导致症状减轻，效应量较大（Hedge's g=-1.161，95%置信区间-1.823 至-0.499；p=0.015）和中等（Hedge's g=-0.680，95%置信区间：-0.139 至-0.322；p≤0.001）。结果进一步表明，在刺激后 2 至 4 周内，治疗的症状减轻效果具有显著的持久性（Hedge's g=-0.909，95%置信区间：-1.611 至-0.207；p=0.011）。右侧背外侧前额叶皮层的 rTMS 似乎对减轻创伤后应激障碍患者的核心症状有积极作用。
