Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Psychiatric Center of Ballerup, Copenhagen University Hospital, Denmark.
Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Psychiatry Region Zealand East, Roskilde, Denmark.
J Psychiatr Res. 2021 Nov;143:163-175. doi: 10.1016/j.jpsychires.2021.09.001. Epub 2021 Sep 3.
Through imaging studies, a significant increase in cerebral activity has been detected in fronto-temporal areas in patients experiencing auditory verbal hallucinations. Therefore, non-invasive neuromodulation, in particular transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), has been considered as a therapeutic intervention for medication-resistant auditory verbal hallucinations in schizophrenia. We aimed to synthesize results from randomized trials on either rTMS or tDCS versus placebo in patients with schizophrenia by including five recently published trials in the field. A systematic review and meta-analysis of relevant literature was conducted. Studies were included on the basis of pre-defined selection criteria. The quality of the studies was assessed by the Cochrane Risk of Bias Tool for Randomized Controlled Trials. RevMan 5.3 was used to conduct the statistical analysis. Including 465 and 960 patients, respectively, 12 tDCS and 27 rTMS studies were included. Regarding treatment of medication refractory auditory verbal hallucinations, no significant effect of tDCS (-0.23 [-0.49, 0.02], p = 0.08) or rTMS (-0.19 [-0.50, 0,11], p = 0.21) was found compared to sham in this meta-analysis. The current study found that it cannot be concluded that rTMS and tDCS are efficacious in treating medication-resistant auditory verbal hallucinations. Larger randomized controlled tDCS trials of a higher quality should be conducted in the future to establish substantial evidence of tDCS. The interventions appear safe and may have beneficial effects on other outcomes.
通过影像学研究，在经历听觉言语幻觉的患者的额颞区检测到大脑活动的显著增加。因此，非侵入性神经调节，特别是经颅直流电刺激（tDCS）和重复经颅磁刺激（rTMS），已被认为是治疗精神分裂症药物抵抗性听觉言语幻觉的一种治疗干预手段。我们旨在通过纳入该领域的五项最新试验，综合 rTMS 或 tDCS 与安慰剂在精神分裂症患者中的随机试验结果。对相关文献进行了系统评价和荟萃分析。根据预先确定的选择标准纳入研究。使用 Cochrane 随机对照试验偏倚风险工具评估研究的质量。使用 RevMan 5.3 进行统计分析。分别纳入 465 名和 960 名患者，纳入 12 项 tDCS 研究和 27 项 rTMS 研究。关于治疗药物难治性听觉言语幻觉，本荟萃分析未发现 tDCS（-0.23[-0.49,0.02]，p=0.08）或 rTMS（-0.19[-0.50,0,11]，p=0.21）与假刺激相比有显著效果。本研究发现，不能得出 rTMS 和 tDCS 对治疗药物抵抗性听觉言语幻觉有效的结论。未来应开展更大规模、更高质量的随机对照 tDCS 试验，以建立 tDCS 的实质性证据。这些干预措施似乎是安全的，并可能对其他结果产生有益影响。
