Department of Psychiatry, E-DA Dachang Hospital, I-Shou University, Kaohsiung, Taiwan; Department of Psychaitry, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan.
Neurosci Biobehav Rev. 2024 Jul;162:105704. doi: 10.1016/j.neubiorev.2024.105704. Epub 2024 May 7.
This study aimed to evaluate the association of the six parameters, namely stimulation intensity, stimulation frequency, pulses per session, treatment duration, number of sessions, and total number of pulses with the efficacy of conventional transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex for patients with treatment-resistant depression (TRD). A random-effects dose-response meta-analysis of blinded randomized controlled trials (RCTs) involving 2391 participants were conducted to examine the dose-effect relationship of six stimulation parameters. Any of the six parameters significantly individually predicted proportion of variance in efficacy: pulses per session (R²=52.7%), treatment duration (R²=51.2%), total sessions (R²=50.9%), frequency (R²=49.6%), total pulses (R²=49.5%), and intensity (R²= 40.4%). Besides, we identified frequency as a potential parameter interacting with the other five parameters, resulting in a significant increase in variance(ΔR) ranging from 5.0% to 16.7%. Finally, we found that RCTs using frequency > 10 Hz compared to those of 10 Hz showed better dose-effect relationships. We conclude that the six stimulation parameters significantly predict the dose-effect relationship of conventional rTMS on TRD. Besides, higher stimulation frequency, higher stimulation intensity, and adequate number of pulses were associated with treatment efficacy.
本研究旨在评估六个参数（刺激强度、刺激频率、每个疗程的脉冲数、治疗持续时间、疗程数和总脉冲数）与常规经颅磁刺激（rTMS）治疗难治性抑郁症（TRD）患者左背外侧前额叶皮质疗效的相关性。对涉及 2391 名参与者的 27 项双盲随机对照试验（RCT）进行了随机效应剂量-反应荟萃分析，以检验六个刺激参数的剂量-效应关系。六个参数中的任何一个参数都显著地单独预测了疗效的方差比例：每个疗程的脉冲数（R²=52.7%）、治疗持续时间（R²=51.2%）、总疗程数（R²=50.9%）、频率（R²=49.6%）、总脉冲数（R²=49.5%）和强度（R²=40.4%）。此外，我们发现频率是一个与其他五个参数相互作用的潜在参数，导致方差的显著增加（ΔR）范围为 5.0%至 16.7%。最后，我们发现使用频率>10 Hz 的 RCT 与使用频率为 10 Hz 的 RCT 相比，具有更好的剂量-效应关系。我们得出结论，六个刺激参数显著预测了常规 rTMS 对 TRD 的剂量-效应关系。此外，较高的刺激频率、较高的刺激强度和足够的脉冲数与治疗效果相关。
