Gay Florian, Singier Allison, Aouizerate Bruno, Salvo Francesco, Bienvenu Thomas C M
Université de Bordeaux, Bordeaux, France.
Centre de Référence Régional des Pathologies Anxieuses et de la Dépression, Pôle de Psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, France.
Front Psychiatry. 2022 Jul 1;13:910897. doi: 10.3389/fpsyt.2022.910897. eCollection 2022.
Pathological anxiety is responsible for major functional impairments and resistance to conventional treatments in anxiety disorders (ADs), posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Focal neuromodulation therapies such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS) are being developed to treat those disorders.
We performed a dimensional systematic review and meta-analysis to assess the evidence of the efficacy of TMS, tDCS and DBS in reducing anxiety symptoms across ADs, PTSD and MDD. Reports were identified through systematic searches in PubMed/Medline, Scopus and Cochrane library (inception to November 2020), followed by review according to the PRISMA guidelines. Controlled clinical trials examining the effectiveness of brain stimulation techniques on generic anxiety symptoms in patients with ADs, PTSD or MDD were selected.
Nineteen studies (RCTs) met inclusion criteria, which included 589 participants. Overall, focal brain activity modulation interventions were associated with greater reduction of anxiety levels than controls [SMD: -0.56 (95% CI, -0.93 to-0.20, = 77%]. Subgroup analyses revealed positive effects for TMS across disorders, and of focal neuromodulation in generalized anxiety disorder and PTSD. Rates of clinical responses and remission were higher in the active conditions. However, the risk of bias was high in most studies.
There is moderate quality evidence for the efficacy of neuromodulation in treating pathological anxiety.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=233084, identifier: PROSPERO CRD42021233084. It was submitted on January 29th, 2021, and registered on March 1st, 2021. No amendment was made to the recorded protocol. A change was applied for the subgroup analyses based on target brain regions, we added the putative nature (excitatory/inhibitory) of brain activity modulation.
病理性焦虑是焦虑症（AD）、创伤后应激障碍（PTSD）和重度抑郁症（MDD）中主要功能障碍及对传统治疗产生抵抗的原因。经颅磁刺激（TMS）、经颅直流电刺激（tDCS）和深部脑刺激（DBS）等局部神经调节疗法正在被开发用于治疗这些疾病。
我们进行了一项维度系统评价和荟萃分析，以评估TMS、tDCS和DBS在减轻AD、PTSD和MDD患者焦虑症状方面疗效的证据。通过在PubMed/Medline、Scopus和Cochrane图书馆（从创刊到2020年11月）进行系统检索来识别报告，随后根据PRISMA指南进行综述。选择了检验脑刺激技术对AD、PTSD或MDD患者一般焦虑症状有效性的对照临床试验。
19项研究（随机对照试验）符合纳入标准，包括589名参与者。总体而言，局部脑活动调节干预与比对照组更大程度地降低焦虑水平相关[标准化均数差：-0.56（95%可信区间，-0.93至-0.20，I² = 77%）]。亚组分析显示TMS对所有疾病均有积极作用，且局部神经调节对广泛性焦虑症和PTSD有积极作用。在积极治疗组中临床反应和缓解率更高。然而，大多数研究中的偏倚风险较高。
有中等质量的证据支持神经调节治疗病理性焦虑的疗效。
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=233084，标识符：PROSPERO CRD42021233084。于2021年1月29日提交，并于2021年3月1日注册。记录的方案未作修改。基于目标脑区进行亚组分析申请了一项变更，我们增加了脑活动调节的假定性质（兴奋性/抑制性）。
