Blyth Sophia H, Cruz Bosch Claudia, Raffoul Julian J, Chesley Jordyn, Johnson Benjamin, Borodge Darara, Sagarwala Raza, Masters Ross, Brady Roscoe O, Vandekar Simon, Ward Heather Burrell
Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Psychiatry, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA.
Schizophr Bull. 2025 Mar 14;51(2):392-400. doi: 10.1093/schbul/sbae158.
Current treatments for schizophrenia are only partially effective, and there are no medications for negative symptoms or cognitive impairment. Neuromodulation, such as repetitive transcranial magnetic stimulation (rTMS), has potential as a novel intervention for schizophrenia. Prior to clinical use, rTMS should have demonstrated safety in a large schizophrenia population. However, the safety profile of rTMS in schizophrenia is not well characterized, and regulatory agencies have expressed concern about safety in this population.
We conducted a systematic review with meta-analysis of rTMS studies in schizophrenia. We searched PubMed, the Cochrane Library, PsycINFO, and Science Citation Index Expanded for rTMS studies in schizophrenia that reported adverse effects. We extracted the number of participants who experienced an adverse effect and calculated the prevalence of each adverse effect for active or sham rTMS. We tested the difference between the prevalence of events in the active and sham conditions. We assessed risk of bias using the Cochrane Handbook.
The initial search identified 1472 studies. After screening, 261 full-text studies were assessed, and 126 met inclusion criteria (N = 4122 total subjects). The prevalence of headache or scalp pain, dizziness or syncope, facial twitching, and nausea was higher for active rTMS compared to sham (P < .05). The prevalence of all other adverse effects, including seizure, was not different between active and sham rTMS.
rTMS is safe and well tolerated for people with schizophrenia. Individuals with schizophrenia are not at increased risk for adverse effects, including seizure, compared to the general population.
目前治疗精神分裂症的方法仅部分有效，且尚无针对阴性症状或认知障碍的药物。神经调节，如重复经颅磁刺激（rTMS），具有作为精神分裂症新型干预措施的潜力。在临床应用之前，rTMS应已在大量精神分裂症患者中证明其安全性。然而，rTMS在精神分裂症中的安全性特征尚不明确，监管机构已对该人群的安全性表示担忧。
我们对精神分裂症患者的rTMS研究进行了系统评价和荟萃分析。我们在PubMed、Cochrane图书馆、PsycINFO和科学引文索引扩展版中搜索了报告不良反应的精神分裂症患者的rTMS研究。我们提取了出现不良反应的参与者数量，并计算了主动或假rTMS的每种不良反应的发生率。我们测试了主动和假刺激条件下事件发生率的差异。我们使用Cochrane手册评估偏倚风险。
初步搜索确定了1472项研究。筛选后，评估了261项全文研究，其中126项符合纳入标准（共4122名受试者）。与假刺激相比，主动rTMS的头痛或头皮疼痛、头晕或晕厥、面部抽搐和恶心的发生率更高（P < 0.05）。主动和假rTMS之间所有其他不良反应的发生率，包括癫痫发作发生率，没有差异。
rTMS对精神分裂症患者是安全且耐受性良好的。与普通人群相比，精神分裂症患者出现包括癫痫发作在内的不良反应的风险并未增加。
