Safety of rTMS for Schizophrenia: A Systematic Review and Meta-analysis.

IF 5.3 1区 医学 Q1 PSYCHIATRY
Sophia H Blyth, Claudia Cruz Bosch, Julian J Raffoul, Jordyn Chesley, Benjamin Johnson, Darara Borodge, Raza Sagarwala, Ross Masters, Roscoe O Brady, Simon Vandekar, Heather Burrell Ward
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Abstract

Background and hypothesis: 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.

Study design: 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.

Study results: 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.

Conclusions: 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.

经颅磁刺激治疗精神分裂症的安全性:系统回顾与元分析》。
背景与假设:目前治疗精神分裂症的方法只有部分有效,而且没有治疗阴性症状或认知障碍的药物。重复经颅磁刺激(rTMS)等神经调节疗法有可能成为治疗精神分裂症的新型干预手段。在临床使用之前,经颅磁刺激应在大量精神分裂症患者中证明其安全性。然而,经颅磁刺激治疗精神分裂症的安全性尚不明确,监管机构对该人群的安全性表示担忧:我们对经颅磁刺激治疗精神分裂症的研究进行了系统回顾和荟萃分析。我们检索了 PubMed、Cochrane 图书馆、PsycINFO 和 Science Citation Index Expanded 中有关精神分裂症经颅磁刺激疗法不良反应的研究。我们提取了出现不良反应的参与者人数,并计算了活性或假性经颅磁刺激每种不良反应的发生率。我们检验了活性和假性条件下不良反应发生率的差异。我们使用 Cochrane 手册评估了偏倚风险:初步检索发现了 1472 项研究。经过筛选,我们评估了 261 项全文研究,其中 126 项符合纳入标准(N = 4122 名受试者)。主动经颅磁刺激与假性经颅磁刺激相比,头痛或头皮痛、头晕或晕厥、面部抽搐和恶心的发生率更高(P 结论:经颅磁刺激对精神分裂症患者安全且耐受性良好。与普通人群相比,精神分裂症患者出现不良反应(包括癫痫发作)的风险并没有增加。
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来源期刊
Schizophrenia Bulletin
Schizophrenia Bulletin 医学-精神病学
CiteScore
11.40
自引率
6.10%
发文量
163
审稿时长
4-8 weeks
期刊介绍: Schizophrenia Bulletin seeks to review recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. We view the field as broad and deep, and will publish new knowledge ranging from the molecular basis to social and cultural factors. We will give new emphasis to translational reports which simultaneously highlight basic neurobiological mechanisms and clinical manifestations. Some of the Bulletin content is invited as special features or manuscripts organized as a theme by special guest editors. Most pages of the Bulletin are devoted to unsolicited manuscripts of high quality that report original data or where we can provide a special venue for a major study or workshop report. Supplement issues are sometimes provided for manuscripts reporting from a recent conference.
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