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

Autor: Tseng PT; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan.; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan., Zeng BY; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.; Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan., Wang HY; Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan., Zeng BS; Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, I-Shou University, Kaohsiung, Taiwan., Liang CS; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan.; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan., Chen YB; Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan., Stubbs B; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK.; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK., Carvalho AF; Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia., Brunoni AR; Service of Interdisciplinary Neuromodulation, National Institute of Biomarkers in Psychiatry, Laboratory of Neurosciences (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil.; Departamento de Ciências Médicas, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil., Su KP; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK.; Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.; College of Medicine, China Medical University, Taichung, Taiwan.; An-Nan Hospital, China Medical University, Tainan, Taiwan., Tu YK; Institute of Health Data Analytics & Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan.; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan., Wu YC; Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan., Chen TY; Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan.; Institute of Brain Science, National Yang Ming Chiao Tung University, Taiwan., Li DJ; Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan., Lin PY; Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan., Chen YW; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan., Hsu CW; Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan., Hung KC; Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan., Shiue YL; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan., Li CT; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.; Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taiwan.; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang Ming Chiao Tung University, Taiwan.
Jazyk: angličtina
Zdroj: Acta psychiatrica Scandinavica [Acta Psychiatr Scand] 2024 Jul; Vol. 150 (1), pp. 5-21. Date of Electronic Publication: 2024 Apr 14.
DOI: 10.1111/acps.13688
Abstrakt: 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.
(© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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