Sabe, Michel, Hyde, Joshua and Cramer, Catharina , (2024) Transcranial magnetic stimulation and transcranial direct current stimulation across mental disorders: a systematic review and dose-response meta-analyses. JAMA Network Open. (In Press)
Abstract
Importance: non-invasive brain stimulation (NIBS) interventions are efficacious in several mental disorders, but the optimal dose stimulation parameters for each disorder are unknown.
Objective: to define NIBS dose stimulation parameters associated with the greatest efficacy in symptom improvement across mental disorders.
Data sources: we drew on, and updated to April 30th, 2023, a previous PRISMA 2020-compliant systematic review (CRD42021250057), based on a search in PubMed, OVID, and Web of Knowledge.
Study selection: we selected randomized controlled trials (RCTs) that tested transcranial magnetic stimulation (TMS) or transcranial direct-current stimulation (tDCS) for any mental disorder in adults.
Data extraction and synthesis: two authors independently extracted the data. We conducted a one-stage dose-response meta-analysis using a random-effects model. Sensitivity analyses were conducted to test robustness of the findings.
Main outcomes and measures: to determine the near-maximum effective doses of total pulses received for TMS and total current dose for tDCS.
RESULTS We included 116 studies encompassing 4,903 participants (61.3% men; mean age of 42.3±8.8-year-old). The following significant dose-response associations emerged, with bell-shaped curves: i) in schizophrenia, high-frequency (HF)TMS, on left dorsolateral prefrontal cortex (LDLPFC), for negative symptoms, and TMS, on left temporoparietal junction (LTPJ) for resistant hallucinations; ii) in depression, HFTMS on the left dorsolateral prefrontal cortex (DLPFC); iii) in treatment-resistant depression, tDCS on LDLPFC; iv) in substance use disorder, tDCS on the LDLPFC and right(R)DLPFC. Curves that plateaued or ascended were v) low-frequency(LF)TMS on the RDLPFC for depression, and LF-BLDLPFC for treatment-resistant depression; vi) in obsessive-compulsive disorder, LFTMS on the RDLPFC, with ascending curve, as well as LFTMS on the orbito-frontal cortex with a curve that plateaued; and vii) in post-traumatic stress disorder, LFTMS on the RDLPFC, with ascending curve. Sensitivity analyses confirmed the main findings.
Conclusions and relevance: in our systematic review and dose-response meta-analysis, we discovered that NIBS yield specific effects based on dose parameters across various mental disorders and brain regions. Clinicians should consider these dose parameters when prescribing NIBS. Additional research is needed to prospectively validate our findings in randomized, sham-controlled trials and explore how other parameters contribute to the observed dose-response association.
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