Che Jiang, Yong Yang, Lili Wu, Weizhi Liu, Gang Zhao
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Both randomized controlled trials (RCTs) and open trials of LF rTMS on PTSD were included, and we additionally included RCTs comparing HF rTMS and sham treatment on PTSD. First, we qualitatively summarized parameters of LF rTMS treatment; then, we extracted data from the LF rTMS treatment subgroups of these studies to examine its effect size and potential influencing factors; third, we compared the effect sizes among LF rTMS, HF rTMS and sham treatment through network meta-analysis of RCTs.</p><p><strong>Results: </strong>In all, 15 studies with a sample size of 542 participants were included. The overall effect size for LF rTMS as a treatment for PTSD was found as Hedges' <i>g</i> = 1.02 (95% CI (0.56, 1.47)). Meta-regression analysis did not reveal any influencing factors. 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引用次数: 0
摘要
背景：重复经颅磁刺激（rTMS）对治疗创伤后应激障碍（PTSD）具有潜在的益处。低频经颅磁刺激可降低神经元的兴奋性，与高频经颅磁刺激相比，其安全性可能更高。然而，目前还缺乏专门针对低频经颅磁刺激的荟萃分析：具体探讨低频经颅磁刺激治疗创伤后应激障碍的有效性和安全性：方法：系统检索了从开始到2023年10月17日的数据库，包括PubMed、EMBASE、MEDLINE和Web of Science。其中既包括低频经颅磁刺激治疗创伤后应激障碍的随机对照试验（RCT），也包括开放性试验；此外，我们还纳入了比较高频经颅磁刺激和假治疗创伤后应激障碍的 RCT。首先，我们对低频经颅磁刺激治疗的参数进行了定性总结；然后，我们提取了这些研究中低频经颅磁刺激治疗亚组的数据，以考察其效应大小和潜在的影响因素；第三，我们通过对RCTs进行网络荟萃分析，比较了低频经颅磁刺激、高频经颅磁刺激和假治疗的效应大小：结果：共纳入 15 项研究，样本量为 542 人。发现低频经颅磁刺激治疗创伤后应激障碍的总体效应大小为Hedges' g = 1.02 (95% CI (0.56, 1.47))。元回归分析未发现任何影响因素。网络荟萃分析显示，与假治疗相比，只有右侧背外侧前额叶皮层（DLPFC）的高频经颅磁刺激在改善创伤后应激障碍症状方面表现出显著优势，而右侧DLPFC的低频经颅磁刺激表现出优势趋势，但差异不显著：结论：现有文献表明，低频经颅磁刺激对治疗各种创伤事件导致的创伤后应激障碍有一定效果。然而，目前有限的 RCT 研究仅显示低频经颅磁刺激在治疗外部创伤事件导致的创伤后应激障碍方面与假治疗相比具有优势趋势。未来，需要进行更多的 RCT 研究来证实低频经颅磁刺激的疗效。此外，还需要研究阐明其潜在机制，以进一步提高其在不同创伤人群中的疗效：CRD42023470169。
Low-frequency repetitive transcranial magnetic stimulation for the treatment of post-traumatic stress disorder and its comparison with high-frequency stimulation: a systematic review and meta-analysis.
Background: Repetitive transcranial magnetic stimulation (rTMS) showed potentially beneficial effects for the treatment of post-traumatic stress disorder (PTSD). Low-frequency (LF) rTMS decreases neuronal excitability and may have better safety compared to high-frequency (HF) rTMS. However, there lacks meta-analysis specifically focusing on LF rTMS.
Objectives: To specifically explore the efficacy and safety of LF rTMS for treating PTSD.
Methods: Databases including PubMed, EMBASE, MEDLINE, and Web of Science were systematically searched from inception to October 17, 2023. Both randomized controlled trials (RCTs) and open trials of LF rTMS on PTSD were included, and we additionally included RCTs comparing HF rTMS and sham treatment on PTSD. First, we qualitatively summarized parameters of LF rTMS treatment; then, we extracted data from the LF rTMS treatment subgroups of these studies to examine its effect size and potential influencing factors; third, we compared the effect sizes among LF rTMS, HF rTMS and sham treatment through network meta-analysis of RCTs.
Results: In all, 15 studies with a sample size of 542 participants were included. The overall effect size for LF rTMS as a treatment for PTSD was found as Hedges' g = 1.02 (95% CI (0.56, 1.47)). Meta-regression analysis did not reveal any influencing factors. Network meta-analysis showed that compared to sham treatment, only HF rTMS on the right dorsolateral prefrontal cortex (DLPFC) demonstrated a significant advantage in ameliorating PTSD symptoms, while LF rTMS on the right DLPFC showed a trend toward advantage, but the difference was not significant.
Conclusion: The current literature shows LF rTMS has effect in treating PTSD caused by various traumatic events. However, present limited number of RCT studies only showed LF rTMS to have a trend of advantage compared to sham treatment in treating PTSD caused by external traumatic events. In the future, more RCTs are needed to be made to confirm the efficacy of LF rTMS. Additionally, studies are required to elucidate the underlying mechanism in order to further improve its efficacy in different traumatic populations.
期刊介绍：
Therapeutic Advances in Psychopharmacology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of psychopharmacology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in psychopharmacology, providing a forum in print and online for publishing the highest quality articles in this area.
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