与经颅磁刺激治疗自闭症谱系障碍相关的不良反应发生率：一项系统评价和荟萃分析。
Prevalence of Adverse Effects Associated With Transcranial Magnetic Stimulation for Autism Spectrum Disorder: A Systematic Review and Meta-Analysis.
作者信息
Huashuang Zhang, Yang Li, Chensheng Hou, Jing Xin, Bo Chen, Dongming Zhang, Kangfu Liang, Shi-Bin Wang
机构信息
Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China.
Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, China.
出版信息
Front Psychiatry. 2022 May 23;13:875591. doi: 10.3389/fpsyt.2022.875591. eCollection 2022.
BACKGROUND
A growing number of studies have suggested that transcranial magnetic stimulation (TMS) may represent a novel technique with both investigative and therapeutic potential for autism spectrum disorder (ASD). However, a full spectrum of the adverse effects (AEs) of TMS used in ASD has not been specifically and systematically evaluated.
OBJECTIVE
This systematic review and meta-analysis was to assess the prevalence of AEs related to TMS in ASD and to further explore the potentially related factors on the AEs.
METHODS
A systematic literature research of articles published before 31 December 2020 was conducted in the databases of PubMed, Embase, Cochrane Library, Ovid, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP, and WANFANG DATA. AEs reported in the studies were carefully examined and synthesized to understand the safety and tolerability of TMS among ASD. Then, subgroup and sensitivity analyses were performed to examine the potentially related factors on the AEs. PROSPERO registration number: CRD42021239827.
RESULTS
Eleven studies were included in the meta-analysis. The pooled prevalence with 95% confidence interval (CI) of AEs was calculated (overall AEs: 25%, 95% CI 18-33%; headache: 10%, 95% CI 3-19%; facial discomfort: 15%, 95% CI 4-29%; irritability 21%, 95% CI 8-37%; pain at the application site: 6%, 95% CI 0-19%; headedness or dizziness: 8%, 95% CI 0-23%). All reported AEs were mild and transient with relatively few serious AEs and can be resolved after having a rest or medication. In addition, the following variables showed no significant change in overall prevalence of AEs: the purpose of using TMS, mean age of participants, whether the stimulation site was dorsolateral pre-frontal cortex (DLPFC), intensity of TMS, and the number of stimulation sessions.
CONCLUSION
The overall prevalence of reported AEs of TMS among ASD was 25%. No identified ASD-specific risk factors for TMS-induced AEs were found. Further studies are needed to clarify the variation in the prevalence.
SYSTEMATIC REVIEW REGISTRATION
www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=239827, PROSPERO, identifier: CRD42021239827.
背景
越来越多的研究表明，经颅磁刺激（TMS）可能是一种对自闭症谱系障碍（ASD）具有研究和治疗潜力的新技术。然而，尚未对ASD中使用TMS的全面不良反应（AE）进行专门和系统的评估。
目的
本系统评价和荟萃分析旨在评估ASD中与TMS相关的AE的发生率，并进一步探讨AE的潜在相关因素。
方法
在PubMed、Embase、Cochrane图书馆、Ovid、PsycINFO、中国知网（CNKI）、重庆维普和万方数据等数据库中，对2020年12月31日前发表的文章进行系统文献检索。仔细检查和综合研究中报告的AE，以了解TMS在ASD中的安全性和耐受性。然后，进行亚组分析和敏感性分析，以研究AE的潜在相关因素。PROSPERO注册号：CRD42021239827。
结果
11项研究纳入荟萃分析。计算了AE的合并患病率及95%置信区间（CI）（总体AE：25%，95%CI 18-33%；头痛：10%，95%CI 3-19%；面部不适：15%，95%CI 4-29%；易怒：21%，95%CI 8-37%；应用部位疼痛：6%，95%CI 0-19%；头晕或眩晕：8%，95%CI 0-23%）。所有报告的AE均为轻度且短暂，严重AE相对较少，休息或用药后可缓解。此外，以下变量在AE的总体患病率方面无显著变化：使用TMS的目的、参与者的平均年龄、刺激部位是否为背外侧前额叶皮质（DLPFC）、TMS强度以及刺激次数。
结论
ASD中报告的TMS的AE总体患病率为25%。未发现ASD特异性的TMS诱导AE的危险因素。需要进一步研究以阐明患病率的差异。
系统评价注册
www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=239827，PROSPERO，标识符：CRD42021239827。
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