Efficacy and tolerability of repetitive transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis.
Efficacy and tolerability of repetitive transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis.
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DOI：
10.1038/s41398-021-01453-0
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发表时间：
2021-05-28
影响因子：
6.8
通讯作者：
Huang X
中科院分区：
文献类型：
--
作者：
Liang K;Li H;Bu X;Li X;Cao L;Liu J;Gao Y;Li B;Qiu C;Bao W;Zhang S;Hu X;Xing H;Gong Q;Huang X
重复经颅磁刺激（rTMS）已被广泛用作强迫症（OCD）的替代治疗。然而，最有效的rTMS参数，如目标和刺激频率，仍然存在争议。因此，我们的目的是比较和排名不同的rTMS策略治疗强迫症的疗效和耐受性。我们检索了5个电子数据库，从其成立之日起至2020年3月25日。进行成对荟萃分析和网络荟萃分析以综合数据。我们使用建议评估、发展和评价分级（GRADE）框架评估证据质量。纳入了22项符合条件的随机对照试验（RCT）。为了有效性，在背外侧前额叶皮层上进行低频（LF）rTMS（DLPFC;平均差（MD）6.34，95%可信区间（CrI）2.12-10.42）和辅助运动区（MD 4.18，95%CrI 0.83-7.62）和DLPFC上的高频rTMS（MD 3.75，95%CrI 1.04-6.81）比假rTMS更有效。关于耐受性，所有rTMS治疗策略与假rTMS相似。治疗的估计排序概率表明，LF-rTMS超过DLPFC可能是所有rTMS策略中最有效的干预措施。然而，关于疗效的证据质量被评价为非常低。目前的证据表明，LF-rTMS在强迫症治疗中的边际优势超过DLPFC。高质量的随机对照试验，低选择和性能的偏见，需要进一步验证特定的rTMS策略治疗强迫症的疗效。
Repetitive transcranial magnetic stimulation (rTMS) has been widely used as an alternative treatment for obsessive-compulsive disorder (OCD). However, the most effective rTMS parameters, such as the targets and stimulation frequencies, remain controversial. Therefore, we aimed to compare and rank the efficacy and tolerability of different rTMS strategies for OCD treatment. We searched five electronic databases from the date of their inception to March 25, 2020. Pairwise meta-analyses and network meta-analyses were performed to synthesize data. We assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Twenty-two eligible randomized controlled trials (RCTs) were included. For efficacy, low-frequency (LF) rTMS over the dorsolateral prefrontal cortex (DLPFC; mean difference (MD) 6.34, 95% credible interval (CrI) 2.12–10.42) and supplementary motor area (MD 4.18, 95% CrI 0.83–7.62), and high-frequency rTMS over the DLPFC (MD 3.75, 95% CrI 1.04–6.81) were more effective than sham rTMS. Regarding tolerability, all rTMS treatment strategies were similar to the sham rTMS. The estimated ranking probabilities of treatments showed that LF-rTMS over the DLPFC might be the most effective intervention among all rTMS strategies. However, the quality of evidence regarding efficacy was evaluated as very low. Current evidence suggested a marginal advantage for LF-rTMS over the DLPFC on OCD treatment. High-quality RCTs with low selection and performance bias are needed to further verify the efficacy of specific rTMS strategies for the OCD treatment.
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影响因子：
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作者：
Luber, Bruce M.;Davis, Simon;Strauman, Timothy J.
通讯作者：
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影响因子：
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DOI：
10.1016/j.rehab.2015.05.005
发表时间：
2015-09-01
影响因子：
4.6
作者：
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通讯作者：
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