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Non-invasive brain stimulation for posttraumatic stress disorder: a systematic review and meta-analysis.

ABSTRACT: Approximately 7-9% of people develop posttraumatic stress disorder in their lifetime, but standard pharmacological treatment or psychotherapy shows a considerable individual variation in their effectiveness. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) hold promise for the treatment of posttraumatic stress disorder. The objective of this meta-analysis was to summarize the existing evidence on the therapeutic effects of these brain stimulation treatments on posttraumatic core symptoms. We systematically retrieved articles published between 1st January 2000 and 1st January 2020 comparing the effects of active with sham stimulation or no intervention in posttraumatic patients from eight databases. Random-effects model was used for meta-analysis. Meta-regression and subgroup meta-analysis was performed to investigate the influence of stimulation dose and different stimulation protocols, respectively. 20 studies were included in this review, where of 11 randomized controlled trials were subjected to quantitative analysis. Active stimulation demonstrated significant reductions of core posttraumatic symptoms with a large effect size (Hedge's g?=?-0.975). Subgroup analysis showed that both excitatory and inhibitory rTMS of the right dorsolateral prefrontal cortex led to symptom reductions with a large (Hedges' g?=?-1.161, 95% CI, -1.823 to -0.499; p?=?0.015) and medium effect size (Hedges' g?=?-0.680, 95% CI: -0.139 to -0.322; p???0.001) respectively. Results further indicated significant durability of symptom-reducing effects of treatments during a two to four weeks period post stimulation (Hedges' g?=?-0.909, 95% CI: -1.611 to -0.207; p?=?0.011). rTMS of the right dorsolateral prefrontal cortex appears to have a positive effect in reducing core symptoms in patients with posttraumatic stress disorder.

SUBMITTER: Kan RLD

PROVIDER: S-EPMC7256039 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Non-invasive brain stimulation for posttraumatic stress disorder: a systematic review and meta-analysis.

Kan Rebecca L D RLD Zhang Bella B B BBB Zhang Jack J Q JJQ Kranz Georg S GS

Translational psychiatry 20200528 1

Approximately 7-9% of people develop posttraumatic stress disorder in their lifetime, but standard pharmacological treatment or psychotherapy shows a considerable individual variation in their effectiveness. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) hold promise for the treatment of posttraumatic stress disorder. The objective of this meta-analysis was to summarize the existing evidence on the therapeutic effects of these brain stimula ...[more]

PMID: 32467579

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Project description:ObjectiveMultiple studies have explored the use of visual cortex non-invasive brain stimulation (NIBS) to enhance visual function. These studies vary in sample size, outcome measures, and methodology. We conducted a systematic review and meta-analyses to assess the effects of NIBS on visual functions in human participants with normal vision.MethodsWe followed the PRISMA guidelines, and a review protocol was registered with PROSPERO before study commencement (CRD42021255882). We searched Embase, Medline, PsychInfo, PubMed, OpenGrey and Web of Science using relevant keywords. The search covered the period from 1st January 2000 until 1st September 2021. Comprehensive meta-analysis (CMA) software was used for quantitative analysis.ResultsFifty studies were included in the systematic review. Only five studies utilized transcranial magnetic stimulation (TMS) and no TMS studies met our pre-specified criteria for meta-analysis. Nineteen transcranial electrical stimulation studies (tES, 38%) met the criteria for meta-analysis and were the focus of our review. Meta-analysis indicated acute effects (Hedges's g = 0.232, 95% CI: 0.023-0.442, p = 0.029) and aftereffects (0.590, 95% CI: 0.182-0.998, p = 0.005) of tES on contrast sensitivity. Visual evoked potential (VEP) amplitudes were significantly enhanced immediately after tES (0.383, 95% CI: 0.110-0.665, p = 0.006). Both tES (0.563, 95% CI: 0.230-0.896, p = 0.001) and anodal-transcranial direct current stimulation (a-tDCS) alone (0.655, 95% CI: 0.273-1.038, p = 0.001) reduced crowding in peripheral vision. The effects of tES on visual acuity, motion perception and reaction time were not statistically significant.ConclusionThere are significant effects of visual cortex tES on contrast sensitivity, VEP amplitude, an index of cortical excitability, and crowding among normally sighted individuals. Additional studies are required to enable a comparable meta-analysis of TMS effects. Future studies with robust experimental designs are needed to extend these findings to populations with vision loss.Clinical trial registrationClinicalTrials.gov/, identifier CRD42021255882.

Project description:BackgroundTo date, only one systematic review and meta-analysis of randomized controlled trials (RCTs) has evaluated the effect of neurofeedback in PTSD, which included only four studies and found an uncertainty of the effect of EEG-NF on PTSD symptoms. This meta-analysis is an update considering that numerous studies have since been published. Additionally, more recent studies have included fMRI-NF as well as fMRI-guided or -inspired EEG NF.MethodsSystematic literature searches for RCTs were conducted in three online databases. Additional hand searches of each study identified and of systematic reviews and meta-analyses published were also undertaken. Outcomes evaluated the effect of neurofeedback vs. a control (active, sham, and waiting list) on their effects in reducing PTSD symptoms using various health instruments. Meta-analytical methods used were inverse variance random-effects models measuring both mean and standardized mean differences. Quality and certainty of the evidence were assessed using GRADE. Adverse events were also evaluated.ResultsA total of 17 studies were identified evaluating a total of 628 patients. There were 10 studies used in the meta-analysis. Results from all studies identified favored neurofeedback's effect on reducing PTSD symptoms including BDI pretest-posttest [mean difference (MD): 8.30 (95% CI: 3.09 to 13.52; P = 0.002; I 2 = 0%)]; BDI pretest-follow-up (MD: 8.75 (95% CI: 3.53 to 13.97; P < 0.00001; I 2 = 0%); CAPS-5 pretest-posttest [MD: 7.01 (95% CI: 1.36 to 12.66; P = 0.02; I 2 = 86%)]; CAPS-5 pretest-follow-up (MD: 10 (95% CI: 1.29 to 21.29; P = 0.006; I 2 = 77%); PCL-5 pretest-posttest (MD: 7.14 (95% CI: 3.08 to 11.2; P = 0.0006; I 2 = 0%); PCL-5 pretest-follow-up (MD: 14.95 (95% CI: 7.95 to 21.96; P < 0.0001; I 2 = 0%). Other studies reported improvements using various other instruments. GRADE assessments of CAPS, PCL, and BDI demonstrated a moderate/high level in the quality of the evidence that NF has a positive clinical effect.ConclusionBased on newer published studies and the outcomes measured, NF has demonstrated a clinically meaningful effect size, with an increased effect size at follow-up. This clinically meaningful effect appears to be driven by newer fMRI-guided NF and deeper brain derivates of it.

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Non-invasive brain stimulation for posttraumatic stress disorder: a systematic review and meta-analysis.

Publications

Non-invasive brain stimulation for posttraumatic stress disorder: a systematic review and meta-analysis.

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