Efficacy of non-invasive brain stimulation and neuronavigation for major depressive disorder: a systematic review and meta-analysis.

Expert review of medical devices Pub Date : 2024-07-01 Epub Date: 2024-06-26 DOI:10.1080/17434440.2024.2370820
Yishai Valter, Fabio Rapallo, Bruno Burlando, Miah Crossen, Chris Baeken, Abhishek Datta, Choi Deblieck
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Abstract

Introduction: Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are increasingly used for major depressive disorder (MDD). Most tDCS and rTMS studies target the left dorsolateral prefrontal cortex, either with or without neuronavigation. We examined the effect of rTMS and tDCS, and the added value of neuronavigation in the treatment of MDD.

Methods: A search on PubMed, Embase, and Cochrane databases for rTMS or tDCS randomized controlled trials of MDD up to 1 February 2023, yielded 89 studies. We then performed meta-analyses comparing tDCS efficacy to non-neuronavigated rTMS, tDCS to neuronavigated rTMS, and neuronavigated rTMS to non-neuronavigated rTMS. We assessed the significance of the effect in subgroups and in the whole meta-analysis with a z-test and subgroup differences with a chi-square test.

Results: We found small-to-medium effects of both tDCS and rTMS on MDD, with a slightly greater effect from rTMS. No significant difference was found between neuronavigation and non-neuronavigation.

Conclusion: Although both tDCS and rTMS are effective in treating MDD, many patients do not respond. Additionally, current neuronavigation methods are not significantly improving MDD treatment. It is therefore imperative to seek personalized methods for these interventions.

无创脑部刺激和神经导航对重度抑郁症的疗效:系统回顾和荟萃分析。
简介重复经颅磁刺激(rTMS)和经颅直流电刺激(tDCS)越来越多地被用于治疗重度抑郁障碍(MDD)。大多数经颅直流电刺激(tDCS)和经颅磁刺激(rTMS)研究都以左侧背外侧前额叶皮层为目标,或使用神经导航,或不使用神经导航。我们研究了经颅磁刺激和经颅磁刺激的效果,以及神经导航在治疗 MDD 中的附加价值:在PubMed、Embase和Cochrane数据库中搜索了截至2023年2月1日的经颅磁刺激或tDCS治疗MDD的随机对照试验,共获得89项研究。然后,我们对 tDCS 与非神经元导航经颅磁刺激、tDCS 与神经元导航经颅磁刺激、神经元导航经颅磁刺激与非神经元导航经颅磁刺激的疗效进行了荟萃分析。我们采用z检验评估了亚组和整个荟萃分析中效应的显著性,并采用卡方检验评估了亚组差异:结果:我们发现 tDCS 和经颅磁刺激对 MDD 均有小到中等程度的疗效,其中经颅磁刺激的疗效稍大。神经导航和非神经导航之间没有发现明显差异:结论:尽管 tDCS 和经颅磁刺激对治疗 MDD 都很有效,但许多患者并无反应。此外,目前的神经导航方法并不能显著改善 MDD 的治疗效果。因此,寻求个性化的干预方法势在必行。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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