The Efficacy and Acceptability of Non-Invasive Brain Stimulation Interventions for Obsessive-Compulsive Disorder Management: A Network Meta-Analysis Based on 24 Stimulation Methods.

IF 5.3 2区 医学 Q1 PSYCHIATRY
Ping-Tao Tseng, Chih-Wei Hsu, Chao-Ming Hung, Chih-Sung Liang, Hung-Yu Wang, Brendon Stubbs, Andre F Carvalho, Andre R Brunoni, Kuan-Pin Su, Yu-Kang Tu, Yi-Cheng Wu, Tien-Yu Chen, Dian-Jeng Li, Pao-Yen Lin, Yen-Wen Chen, Kuo-Chuan Hung, Jiann-Jy Chen, Bing-Syuan Zeng, Cheng-Ta Li
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引用次数: 0

Abstract

Introduction: Despite the high lifetime prevalence and elevated disability rates, treatments for obsessive-compulsive disorder (OCD) have limited efficacy. Considering the abnormal connectivity in the cortical-striatal-thalamic-cortical loop circuits in OCD, several randomized controlled trials (RCTs) have addressed the efficacy of different non-invasive brain stimulation (NIBS) modalities for the management of OCD. However, these RCTs yielded inconclusive results.

Methods: This network meta-analysis (NMA) included RCTs of NIBS interventions, such as transcranial direct current stimulation (tDCS) and various repetitive transcranial magnetic stimulation (rTMS), in OCD patients. The primary outcomes were changes in the overall severity of OCD and acceptability (i.e., dropout rates).

Results: This NMA of 34 eligible RCTs (1089 participants) and 24 different NIBS interventions revealed that three NIBS interventions significantly improved overall OCD severity compared with sham controls, which were high-frequency rTMS over the dorsolateral prefrontal cortex (DLPFC) [mean difference (MD) = -10.81, 95% confidence intervals (95% CIs) = -20.80 to -0.82], high-frequency deep TMS over the dorsal medial prefrontal cortex/anterior cingulate cortex (dmPFC/ACC) (MD = -9.74, 95% CIs = -16.42 to -3.06), and low-frequency rTMS over the right DLPFC (MD = -4.70, 95% CIs = -8.84 to -0.57).

Conclusions: This study highlighted that excitatory stimulation over the dmPFC/ACC and bilateral DLPFC, or inhibitory stimulation over the right DLPFC, was associated with significant improvements in overall OCD severity. Further large-scale RCTs with longer follow-up periods are needed to investigate the true impact of NIBS-based intervention to manage OCD.

Trial registration: PROSPERO: CRD42023394953.

非侵入性脑刺激干预治疗强迫症的有效性和可接受性:基于24种刺激方法的网络meta分析。
导读:尽管强迫症终生患病率高,致残率高,但治疗效果有限。考虑到强迫症患者皮层-纹状体-丘脑-皮层环路的异常连通性,一些随机对照试验(rct)研究了不同的非侵入性脑刺激(NIBS)治疗强迫症的效果。然而,这些随机对照试验得出了不确定的结果。方法:本网络荟萃分析(NMA)纳入强迫症患者NIBS干预措施的随机对照试验,如经颅直流电刺激(tDCS)和各种重复性经颅磁刺激(rTMS)。主要结果是强迫症的总体严重程度和可接受性(即辍学率)的变化。结果:34项符合条件的随机对照试验(1089名参与者)和24种不同的NIBS干预的NMA显示,与假对照组相比,三种NIBS干预显著改善了强迫症的总体严重程度,即经背外侧前额叶皮层(DLPFC)的高频rTMS[平均差(MD) = -10.81, 95%置信区间(95% ci) = -20.80至-0.82],经背内侧前额叶皮层/前扣带皮层(dmPFC/ACC)的高频深度TMS (MD = -9.74,95% ci = -16.42至-3.06),而右侧DLPFC上的低频rTMS (MD = -4.70, 95% ci = -8.84至-0.57)。结论:本研究强调,dmPFC/ACC和双侧DLPFC的兴奋性刺激,或右侧DLPFC的抑制性刺激,与总体强迫症严重程度的显著改善有关。需要进一步的大规模随机对照试验和更长的随访期来调查基于nibs的干预对强迫症的真正影响。试验注册:PROSPERO: CRD42023394953。
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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来源期刊
Acta Psychiatrica Scandinavica
Acta Psychiatrica Scandinavica 医学-精神病学
CiteScore
11.20
自引率
3.00%
发文量
135
审稿时长
6-12 weeks
期刊介绍: Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.
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