TY - JOUR
T1 - Efficacy and acceptability of noninvasive brain stimulation for treating posttraumatic stress disorder symptoms
T2 - A network meta-analysis of randomized controlled trials
AU - Tseng, Ping Tao
AU - Zeng, Bing Yan
AU - Wang, Hung Yu
AU - Zeng, Bing Syuan
AU - Liang, Chih Sung
AU - Chen, Yang Chieh Brian
AU - Stubbs, Brendon
AU - Carvalho, Andre F.
AU - Brunoni, Andre R.
AU - Su, Kuan Pin
AU - Tu, Yu Kang
AU - Wu, Yi Cheng
AU - Chen, Tien Yu
AU - Li, Dian Jeng
AU - Lin, Pao Yen
AU - Chen, Yen Wen
AU - Hsu, Chih Wei
AU - Hung, Kuo Chuan
AU - Shiue, Yow Ling
AU - Li, Cheng Ta
N1 - © 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2024/7
Y1 - 2024/7
N2 - 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.
AB - 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.
KW - network meta-analysis
KW - non-invasive brain stimulation
KW - post-traumatic stress disorder
KW - rTMS
KW - tDCS
KW - Transcranial Direct Current Stimulation/methods
KW - Humans
KW - Treatment Outcome
KW - Transcranial Magnetic Stimulation/methods
KW - Randomized Controlled Trials as Topic
KW - Patient Acceptance of Health Care
KW - Stress Disorders, Post-Traumatic/therapy
KW - Vagus Nerve Stimulation/methods
KW - Network Meta-Analysis
UR - http://www.scopus.com/inward/record.url?scp=85190780090&partnerID=8YFLogxK
U2 - 10.1111/acps.13688
DO - 10.1111/acps.13688
M3 - 文献综述
C2 - 38616056
AN - SCOPUS:85190780090
SN - 0001-690X
VL - 150
SP - 5
EP - 21
JO - Acta Psychiatrica Scandinavica
JF - Acta Psychiatrica Scandinavica
IS - 1
ER -
