Lais B Razza, Miles Wischnewski, Paulo Suen, Stefanie De Smet, Pedro Henrique Rodrigues da Silva, Beatriz Catoira, André R Brunoni, Marie-Anne Vanderhasselt
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引用次数: 0
摘要
目的：经颅直流电刺激（transcranial direct current stimulation，tDCS）对重度抑郁症（MDD）症状的治疗效果不一，部分原因是tDCS方案及其相关诱导电场（E-fields）的实验间差异较大。我们研究了不同tDCS参数的电场强度是否与抗抑郁效果相关：方法：我们对纳入 MDD 患者的安慰剂对照 tDCS 临床试验进行了荟萃分析。检索了从开始到 2023 年 3 月 10 日的 PubMed、EMBASE 和 Web of Science。tDCS方案的效应大小与相关脑区（双侧背外侧前额叶皮层[DLPFC]和双侧舌下前扣带回皮层[sgACC]）的电场模拟（SimNIBS）相关。此外，还调查了 tDCS 反应的调节因素：共纳入了 20 项研究（21 个数据集，1 008 名患者），使用了 11 种不同的 tDCS 方案。结果显示，对 MDD 有中等程度的影响（g = 0.41，95%CI 0.18-0.64），而阴极位置和治疗策略被认为是反应的调节因素。研究发现，效应大小与 tDCS 诱导的 E 场大小呈负相关，DLPFC 右侧额叶和内侧部分（阴极靶区）的 E 场较强，导致效应较小。左侧 DLPFC 和双侧 sgACC 没有发现关联。结论：我们的研究结果强调了在 MDD 临床试验中采用标准化 tDCS 方案的必要性。
An electric field modeling study with meta-analysis to understand the antidepressant effects of transcranial direct current stimulation (tDCS).
Objective: Transcranial direct current stimulation (tDCS) has mixed effects for major depressive disorder (MDD) symptoms, partially owing to large inter-experimental variability in tDCS protocols and their correlated induced electric fields (E-fields). We investigated whether the E-field strength of distinct tDCS parameters was associated with antidepressant effect.
Methods: A meta-analysis was performed with placebo-controlled clinical trials of tDCS enrolling MDD patients. PubMed, EMBASE, and Web of Science were searched from inception to March 10, 2023. Effect sizes of tDCS protocols were correlated with E-field simulations (SimNIBS) of brain regions of interest (bilateral dorsolateral prefrontal cortex [DLPFC] and bilateral subgenual anterior cingulate cortex [sgACC]). Moderators of tDCS responses were also investigated.
Results: A total of 20 studies were included (21 datasets, 1,008 patients), using 11 distinct tDCS protocols. Results revealed a moderate effect for MDD (g = 0.41, 95%CI 0.18-0.64), while cathode position and treatment strategy were found to be moderators of response. A negative association between effect size and tDCS-induced E-field magnitude was seen, with stronger E-fields in the right frontal and medial parts of the DLPFC (targeted by the cathode) leading to smaller effects. No association was found for the left DLPFC and the bilateral sgACC. An optimized tDCS protocol is proposed.
Conclusion: Our results highlight the need for a standardized tDCS protocol in MDD clinical trials.
期刊介绍：
The Revista Brasileira de Psiquiatria (RBP) is the official organ of the Associação Brasileira de Psiquiatria (ABP - Brazilian Association of Psychiatry).
The Brazilian Journal of Psychiatry is a bimonthly publication that aims to publish original manuscripts in all areas of psychiatry, including public health, clinical epidemiology, basic science, and mental health problems. The journal is fully open access, and there are no article processing or publication fees. Articles must be written in English.
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