用于治疗抑郁症的theta波爆发刺激：一项系统评价以及网状和成对荟萃分析

Theta burst stimulation for depression: a systematic review and network and pairwise meta-analysis.

作者信息

Kishi Taro, Ikuta Toshikazu, Sakuma Kenji, Hatano Masakazu, Matsuda Yuki, Wilkening Jonas, Goya-Maldonado Roberto, Tik Martin, Williams Nolan R, Kito Shinsuke, Iwata Nakao

机构信息

Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan.

Department of Communication Sciences and Disorders, School of Applied Sciences, University of Mississippi, University, MS, 38677, USA.

出版信息

Mol Psychiatry. 2024 Dec;29(12):3893-3899. doi: 10.1038/s41380-024-02630-5. Epub 2024 Jun 6.

DOI:10.1038/s41380-024-02630-5

PMID:38844532

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11609094/

Abstract

In clinical practice, theta burst stimulation (TBS) presents as a more efficient and potentially more effective therapeutic modality than conventional repetitive transcranial magnetic stimulation (rTMS), as it allows for the delivery of more stimuli in less time and at similar intensities. To date, accelerated treatment plans according to various continuous (cTBS) and intermittent TBS (iTBS) protocols for depression have been proposed. To investigate which of the TBS protocols provided a favorable risk-benefit balance for individuals with depression, this systematic review and random-effects model network meta-analysis was conducted. The study outcomes included response rate (primary), depression symptom improvement, remission rate, all-cause discontinuation rate, incidence of switch to mania, and incidence of headache/discomfort at treatment site. In this meta-analysis, a total of 23 randomized controlled trials (n = 960, mean age = 41.88 years, with 60.78% females) were included. Approximately 69.57% of the trials included individuals with an exclusive diagnosis of major depressive disorder. The following six TBS protocols (target) were evaluated: cTBS (right-dorsolateral prefrontal cortex [R-DLPFC]), cTBS (R-DLPFC) + iTBS (left-DLPFC [L-DLPFC]), iTBS (L-DLPFC), iTBS (L-DLPFC) + iTBS (R-DLPFC), iTBS (left-dorsomedial prefrontal cortex) + iTBS (right-dorsomedial prefrontal cortex), and iTBS (occipital lobe). Compared to sham, cTBS (R-DLPFC) + iTBS (L-DLPFC), iTBS (L-DLPFC), and iTBS (occipital lobe) had a higher response rate (k = 23); cTBS (R-DLPFC) + iTBS (L-DLPFC) and iTBS (L-DLPFC) dominated in the depression symptom improvement (k = 23); and iTBS (L-DLPFC) had a higher remission rate (k = 15). No significant differences were found for all-cause discontinuation rate (k = 17), incidence of switch to mania (k = 7), and incidence of headache/discomfort at treatment site (k = 10) between any TBS protocols and sham. Thus, cTBS (R-DLPFC) + iTBS (L-DLPFC) and iTBS (L-DLPFC) demonstrate favorable risk-benefit balance for the treatment of depression.

摘要

在临床实践中，与传统重复经颅磁刺激（rTMS）相比，theta爆发刺激（TBS）是一种更高效且可能更有效的治疗方式，因为它能在更短时间内以相似强度传递更多刺激。迄今为止，已有人提出根据各种连续（cTBS）和间歇性TBS（iTBS）方案制定的加速治疗计划用于治疗抑郁症。为了研究哪种TBS方案对抑郁症患者具有良好的风险效益平衡，我们进行了这项系统评价和随机效应模型网络荟萃分析。研究结果包括缓解率（主要指标）、抑郁症状改善情况、缓解率、全因停药率、转为躁狂的发生率以及治疗部位头痛/不适的发生率。在这项荟萃分析中，共纳入了23项随机对照试验（n = 960，平均年龄 = 41.88岁，女性占60.78%）。约69.57%的试验纳入了仅诊断为重度抑郁症的患者。评估了以下六种TBS方案（靶点）：cTBS（右侧背外侧前额叶皮质[R-DLPFC]）、cTBS（R-DLPFC）+ iTBS（左侧背外侧前额叶皮质[L-DLPFC]）、iTBS（L-DLPFC）、iTBS（L-DLPFC）+ iTBS（R-DLPFC）、iTBS（左侧背内侧前额叶皮质）+ iTBS（右侧背内侧前额叶皮质）以及iTBS（枕叶）。与假刺激相比，cTBS（R-DLPFC）+ iTBS（L-DLPFC）、iTBS（L-DLPFC）和iTBS（枕叶）的缓解率更高（k = 23）；cTBS（R-DLPFC）+ iTBS（L-DLPFC）和iTBS（L-DLPFC）在抑郁症状改善方面占优势（k = 23）；iTBS（L-DLPFC）的缓解率更高（k = 15）。在任何TBS方案与假刺激之间，全因停药率（k = 17）、转为躁狂的发生率（k = 7）以及治疗部位头痛/不适的发生率（k = 10）均未发现显著差异。因此，cTBS（R-DLPFC）+ iTBS（L-DLPFC）和iTBS（L-DLPFC）在抑郁症治疗中显示出良好的风险效益平衡。