Neurology Department, Cangzhou City Center Hospital, Cangzhou, 061000, China.
Neurology Department, Cangzhou City Center Hospital, Cangzhou, 061000, China.
J Psychiatr Res. 2024 Feb;170:174-186. doi: 10.1016/j.jpsychires.2023.12.003. Epub 2023 Dec 11.
Based on existing evidence of the effects of the most commonly used non-invasive brain stimulation (NIBS), which includes transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), we conducted a meta-analysis to investigate the cognitive improvement and safety of NIBS on schizophrenia-related cognitive impairment. PubMed, EMBASE, Cochrane Library, and Web of Science were searched. The Cochrane Risk of Bias tool was used to assess the risk of bias of the included RCTs; Review Manager, version 5.4.1, was used to perform the statistical analysis. Twenty double-blind, randomized, sham-controlled trials involving 997 patients were included. As a result, no significant improvement in cognitive function was observed after NIBS treatment. However, the overall treatment effect of the two main NIBS modes (i.e., rTMS and tDCS) was associated with significantly larger improvements in negative symptoms and good tolerability in patients with schizophrenia compared to sham-controls (SMD = -0.56, 95% CI [-1.03, -0.08], p = 0.02, I = 88%). NIBS model and stimulus parameters influenced the effect of NIBS. More favorable effects were observed in patients who received rTMS stimulation (SMD = 0.25, 95% CI [0.01, 0.49], p = 0.04, I = 0%) in the left dorsolateral prefrontal cortex with a stimulation intensity of 20 Hz (p = 0.004) for a period longer than 1 month (p < 0.05). Yet, due to the limited number of included studies and heterogeneity in both study design and target population, the results of this analysis need to be interpreted with caution.
基于最常用的非侵入性脑刺激（NIBS）的现有效果证据，包括经颅磁刺激（TMS）和经颅直流电刺激（tDCS），我们进行了一项荟萃分析，以调查 NIBS 对精神分裂症相关认知障碍的认知改善和安全性。检索了 PubMed、EMBASE、Cochrane 图书馆和 Web of Science。使用 Cochrane 偏倚风险工具评估纳入的 RCT 的偏倚风险；使用 Review Manager，版本 5.4.1，进行统计分析。共纳入 20 项双盲、随机、假对照试验，涉及 997 名患者。结果显示，NIBS 治疗后认知功能无显著改善。然而，与假对照相比，两种主要 NIBS 模式（即 rTMS 和 tDCS）的整体治疗效果与精神分裂症患者的阴性症状显著改善和良好耐受性相关（SMD=-0.56，95%CI[-1.03，-0.08]，p=0.02，I=88%）。NIBS 模式和刺激参数影响 NIBS 的效果。在接受 rTMS 刺激的患者中观察到更有利的效果（SMD=0.25，95%CI[0.01，0.49]，p=0.04，I=0%），刺激强度为 20 Hz（p=0.004），刺激部位为左侧背外侧前额叶，刺激时间超过 1 个月（p<0.05）。然而，由于纳入研究的数量有限，以及研究设计和目标人群的异质性，该分析的结果需要谨慎解释。
