Lorentzen Rasmus, Nguyen Tuan D, McGirr Alexander, Hieronymus Fredrik, Østergaard Søren D
Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Schizophrenia (Heidelb). 2022 Apr 9;8(1):35. doi: 10.1038/s41537-022-00248-6.
Several trials have shown preliminary evidence for the efficacy of transcranial magnetic stimulation (TMS) as a treatment for negative symptoms in schizophrenia. Here, we synthesize this literature in a systematic review and quantitative meta-analysis of double-blind randomized controlled trials of TMS in patients with schizophrenia. Specifically, MEDLINE, EMBASE, Web of Science, and PsycINFO were searched for sham-controlled, randomized trials of TMS among patients with schizophrenia. The effect of TMS vs. sham on negative symptoms in each study was quantified by the standardized mean difference (SMD, Cohen's d) with 95% confidence intervals (95%CI) and pooled across studies using an inverse variance random effects model. We identified 57 studies with a total of 2633 participants that were included in the meta-analysis. The pooled analysis showed statistically significant superiority of TMS (SMD = 0.41, 95%CI: 0.26; 0.56, p-value < 0.001), corresponding to a number needed to treat of 5. Furthermore, stratified analyses suggested that TMS targeting the left dorsolateral prefrontal cortex and using a stimulation frequency >1 Hz was most efficacious. There was, however, substantial heterogeneity and high risk of bias among the included studies. In conclusion, TMS appears to be an efficacious treatment option for patients with schizophrenia suffering from negative symptoms, but the optimal TMS parameters are yet to be established.
多项试验已显示出经颅磁刺激(TMS)作为治疗精神分裂症阴性症状的疗效的初步证据。在此,我们在一项对精神分裂症患者进行TMS治疗的双盲随机对照试验的系统评价和定量荟萃分析中综合了这些文献。具体而言,我们检索了MEDLINE、EMBASE、科学网和PsycINFO,以查找精神分裂症患者中TMS的假对照随机试验。每项研究中TMS与假刺激对阴性症状的影响通过标准化平均差(SMD,科恩d值)及95%置信区间(95%CI)进行量化,并使用逆方差随机效应模型对各研究结果进行汇总。我们确定了57项研究,共2633名参与者纳入荟萃分析。汇总分析显示TMS具有统计学上的显著优势(SMD = 0.41,95%CI:0.26;0.56,p值 < 0.001),相应的治疗所需人数为5。此外,分层分析表明,针对左侧背外侧前额叶皮层且使用刺激频率>1Hz的TMS最为有效。然而,纳入的研究之间存在大量异质性和高偏倚风险。总之,TMS似乎是患有阴性症状的精神分裂症患者的一种有效治疗选择,但最佳的TMS参数尚未确定。
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