Efficacy and acceptability of noninvasive brain stimulation for treating posttraumatic stress disorder symptoms: A network meta-analysis of randomized controlled trials

IF 5.3 2区医学 Q1 PSYCHIATRY Acta Psychiatrica Scandinavica Pub Date : 2024-04-14 DOI:10.1111/acps.13688

Ping-Tao Tseng, Bing-Yan Zeng, Hung-Yu Wang, Bing-Syuan Zeng, Chih-Sung Liang, Yang-Chieh Brian Chen, 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, Chih-Wei Hsu, Kuo-Chuan Hung, Yow-Ling Shiue, Cheng-Ta Li

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Abstract

Introduction

Despite its high lifetime prevalence rate and the elevated disability caused by posttraumatic stress disorder (PTSD), treatments exhibit modest efficacy. In consideration of the abnormal connectivity between the dorsolateral prefrontal cortex (DLPFC) and amygdala in PTSD, several randomized controlled trials (RCTs) addressing the efficacy of different noninvasive brain stimulation (NIBS) modalities for PTSD management have been undertaken. However, previous RCTs have reported inconsistent results. The current network meta-analysis (NMA) aimed to compare the efficacy and acceptability of various NIBS protocols in PTSD management.

Methods

We systematically searched ClinicalKey, Cochrane Central Register of Controlled Trials, Embase, ProQuest, PubMed, ScienceDirect, Web of Science, and ClinicalTrials.gov to identify relevant RCTs. The targeted RCTs was those comparing the efficacy of NIBS interventions, such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and transcutaneous cervical vagal nerve stimulation, in patients with PTSD. The NMA was conducted using a frequentist model. The primary outcomes were changes in the overall severity of PTSD and acceptability (to be specific, rates of dropouts for any reason).

Results

We identified 14 RCTs that enrolled 686 participants. The NMA demonstrated that among the investigated NIBS types, high-frequency rTMS over bilateral DLPFCs was associated with the greatest reduction in overall PTSD severity. Further, in comparison with the sham controls, excitatory stimulation over the right DLPFC with/without excitatory stimulation over left DLPFC were associated with significant reductions in PTSD-related symptoms, including depression and anxiety symptoms, and overall PTSD severity.

Conclusions

This NMA demonstrated that excitatory stimulation over the right DLPFC with or without excitatory stimulation over left DLPFC were associated with significant reductions in PTSD-related symptoms.

Trial registration: PROSPERO CRD42023391562.

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非侵入性脑部刺激治疗创伤后应激障碍症状的疗效和可接受性：随机对照试验网络荟萃分析

导言：尽管创伤后应激障碍（PTSD）的终生患病率很高，而且造成的残疾也很严重，但治疗效果却不明显。考虑到创伤后应激障碍患者的背外侧前额叶皮层（DLPFC）和杏仁核之间存在异常连接，已有多项随机对照试验（RCT）探讨了不同的非侵入性脑刺激（NIBS）模式对治疗创伤后应激障碍的疗效。然而，以往的 RCT 报告结果并不一致。方法我们系统地检索了 ClinicalKey、Cochrane Central Register of Controlled Trials、Embase、ProQuest、PubMed、ScienceDirect、Web of Science 和 ClinicalTrials.gov，以确定相关的 RCT。目标 RCT 是那些比较经颅直流电刺激 (tDCS)、重复经颅磁刺激 (rTMS) 和经皮颈迷走神经刺激等 NIBS 干预措施对创伤后应激障碍患者疗效的 RCT。NMA 采用频数模型进行。主要结果是创伤后应激障碍总体严重程度的变化和可接受性（具体而言，因任何原因辍学的比率）。NMA表明，在所研究的NIBS类型中，双侧DLPFC的高频经颅磁刺激与创伤后应激障碍总体严重程度的最大降低相关。此外，与假对照组相比，对右侧DLPFC进行兴奋性刺激，或不对左侧DLPFC进行兴奋性刺激，都能显著减轻创伤后应激障碍相关症状，包括抑郁和焦虑症状，以及创伤后应激障碍的总体严重程度。结论这项NMA研究表明，对右侧DLPFC进行兴奋性刺激，或不对左侧DLPFC进行兴奋性刺激，都能显著减轻创伤后应激障碍相关症状：试验注册：PREMCOCRD42023391562。

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 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.